Long term assisted feeding in children- A simple solution from caregiver’s perspective

Occasionally, we come across babies who need assistance in feeding. Either their swallowing mechanism is challenged, and often the food particles as well as the saliva enter the wind pipe resulting in repeated episodes of pneumonia needing countless hospitalization and morbidity. There are babies who have spastic paraparesis due to lack of oxygen supply to the brain early on. They need placement of a feeding tube in the food pipe. At times, babies have severe degrees of cleft palate with failure to gain weight. Good palatal repair needs an optimum body weight. Aspiration pneumonia episodes can also be precipitated by a disease called gastroesophageal reflux wherein the stomach contents can be pushed back to the food pipe due to weakness of the muscle guarding the gastric inlet.

In all the above described situations, the baby is left with a PVC tube dangling from one of the nostrils. The caregiver must be cautious so that it is not pulled out inadvertently, or unintentionally by the child himself. Prolong tube placement can cause erosions in the food pipe as it is after all a foreign body that is lodged within. Outdoor games are restricted. The child must lead a sedentary existence. The presence of the feeding tube loosens the junction of the stomach and the food pipe promoting reflux and further complicating the scenario.

A small device can completely change the scenario and reverse the gloom of a dangling feeding tube from the nose of a challenged baby, and that too without much fuss and without a large incision in the abdomen. The device is superlight, made of Silicon which is much less reactive. With the guidance of a 5mm laparoscope, with no added incision, the stomach can be fixed to the abdominal wall, and the device fixed there. Often the feeding can be started within 24 hours of placement of the device. It is a 20 minutes procedure and can be done with a short anesthesia.

Dr. SubhasishSaha, consultant, department of pediatrics, CMRI, C K Birla Hospitals Kolkata explains,“The best part is it is easy and convenient for the mother or the caregiver to handle. A tube dangling from the nose creates a social stigma and the child becomes house bound. A Mickey is a small device not visible from outside and the child can even play outdoors and go to school without any stigma. It also prevents the esophageal injury that is common with long term Ryle’s tube placement”.

Mic-key button is a medical intervention and an alternate way of receiving nutrition for children or adults who are unable to eat by mouth. It is fitted for food to go directly into the stomach through the abdominal walls. The tube allows the intake of food and water that the body requires. When the need for assisted feeding is over, it can just be pulled out. Often, the rent gradually seals on its own within a few weeks. Or else, a small procedure is needed to fix the rent. The only drawback that we are facing is the lack of awareness even among the physicians about the existence of such a wonder device.

The Mickey button scores over all other devices as the parents hardly needs to come back to the hospital every now and then. Parents can easily handle the device and even change the same if needed at home. The child can have a good bath or swim and can play most outdoor games.

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