Feeding problems

[Panders]

May I ask if any setting has a child attending or has attended in the past with a nasogastric tube (also known as an NG)   or a PEG where the child is fed directly into their stomach?

[louby loo]

We had a child due to start with us, but things changed during the six week holiday and she didn't need the tube by the time she actually started she started.

[Panders]

what training had you planned Loubyloo

[BenTapestrySupport]

Know it's not really the same thing, but I had a child who was diabetic and had a pump fitted. We had to calculate the amount needed to be pumped in at meal times. For us though, the biggest issue was what to do if the tube from the pump came out - and parents and diabetic nurse came in and showed us how to replace it if needed. We made sure as many people as possible knew how to do this, but it was the responsibility of just a few to do it (but having more people trained meant that if there were a few people away, we were covered). 

[louby loo]

On 29/07/2021 at 08:21, Panders said:

what training had you planned Loubyloo

We were going to have the child's paediatric nurse come in and train us,.... mum was more than happy to show us though! I had to  explained  to her about insurance etc.

On reflection I think the child's needs were quite low really, it was a few years ago now, but I think the mum said she probably wouldn't need feeding at the setting anyway as she was planning on starting slowly and  gradually building up the 3 hours.

The child did attend with us until school and eventually even stayed for lunch with us.  We just had to ensure she had plenty of a vitamin drink throughout the day.

[Panders]

At the present time, Louby I think what we would be asking is for the nursery, she wont be 2 until December, to possibly give her liquids though the tube because swallowing is a big issue, and whilst giving the liquid appears easy enough it is a little more involved with testing stomach ph levels as well, but it is not beyond possibility that one of us could go into nursery to do it ourselves.  

 We are also worried about her pulling out the tube, let alone another child whose curiosity is aroused.  She hasn't had to have the tube inserted for a very long time - but even at a few weeks old she pulled it out regularly, little monkey.   

[louby loo]

3 hours ago, Panders said:

At the present time, Louby I think what we would be asking is for the nursery, she wont be 2 until December, to possibly give her liquids though the tube because swallowing is a big issue, and whilst giving the liquid appears easy enough it is a little more involved with testing stomach ph levels as well, but it is not beyond possibility that one of us could go into nursery to do it ourselves.  

 We are also worried about her pulling out the tube, let alone another child whose curiosity is aroused.  She hasn't had to have the tube inserted for a very long time - but even at a few weeks old she pulled it out regularly, little monkey.   

I must admit I was actually quite relieved when we didn't have to do it in in end- as the tube itself would have been my worry, but we would have found a way round it somehow.

You have reminded though, that a couple of months ago we did have a parent requesting a place (she wanted it immediately and we didn't actually have any spaces). Her son was tube fed but she had said she would be available to come in straight away to fed/deal with any issues. 

[Panders]

Well I am pleased to report that her nursery provider is very keen to support the family and wants the staff to go on training, which they think will be good for them!

[Gill Palfrey_1405476146]

We had a child with us that had liquid through a peg. You need to get a qualified person to train you to use it and sign a medical form to say you’ve been trained. 
Once you’ve done it a couple of times it becomes simpler and less of a worry to do. The child was very happy to sit and have it done which was great. 
just be mindful of any problems with it and who to call in an emergency 

[Panders]

4 hours ago, Gill Palfrey_1405476146 said:

We had a child with us that had liquid through a peg. You need to get a qualified person to train you to use it and sign a medical form to say you’ve been trained. 
Once you’ve done it a couple of times it becomes simpler and less of a worry to do. The child was very happy to sit and have it done which was great. 
just be mindful of any problems with it and who to call in an emergency 

Thank you for your reply Gill,   we are all hoping to avoid the PEG if we can, but the little one will need an operation in September now to close a cleft.   The NG tube will go in for a few weeks before that.    I'm glad the nursery wish to try and are looking into training etc.,  I did have one of those moments a little while ago when I thought ahh, how does this sit with Insurance - if the staff members are trained, obviously by a professional, is that good enough for the Insurance company and would they need to be informed beforehand that this was happening at some point.

[finleysmaid]

21 hours ago, Panders said:

Thank you for your reply Gill,   we are all hoping to avoid the PEG if we can, but the little one will need an operation in September now to close a cleft.   The NG tube will go in for a few weeks before that.    I'm glad the nursery wish to try and are looking into training etc.,  I did have one of those moments a little while ago when I thought ahh, how does this sit with Insurance - if the staff members are trained, obviously by a professional, is that good enough for the Insurance company and would they need to be informed beforehand that this was happening at some point.

anything that is classed as invasive needs to be signed off by the insurance company before little ones start. We have paediatric specialist nurses who come in and train us and sign us off as having been trained. All paperwork etc then needs to be sent to the insurance company. 

Most specialist needs can be dealt with well in the setting and the willingness of the nursery fills me with hope. At the start of their sessions staff tend to be over cautious but it really doesn't take too long before every thing settles down. We havent had any children with feeding tubes (though i have experienced with my daughters friend) we have dealt with a little one with severe cleft, (through hard and soft palate), stoma care, diabetes, and pan-hypo-thyroism (needing specialist care) amongst other things....All of these children have done really well in the setting and become a really important member of the group. The other children see any difficulties as just part of them, once explained they ask a few questions and then just accept the situation....❤️

I would just make sure that a defined health care plan is in place to ensure everyone knows what to do if there is a problem.   

[Panders]

Thank you Finleysmaid.   I will get them to check about insurance etc.  They do know the little one really well she has been attending the nursery since January - although has needed many days off to cope with chest infections, in the main caused by having this very tiny cleft and liquids aspirating into her lung.  The op to close it is why the ng tube is needed initially to ensure she has no infections.    We cant rule out the need for a PEG afterwards however.