Sarah Cunningham and Carolyn Best outline advice for the care of children with feeding difficulties

Endoscopic placement of a gastrostomy is the safest method of inserting a gastrostomy in children who are going to require full or supplemental enteral feeding for more than six weeks. Once a stoma tract has formed successfully following initial placement of a gastrostomy tube, the device can be changed to a balloon, button or non-balloon type. Community nursing teams often support a number of children with gastrostomies and their families, replacing the devices as necessary. Guidance for the safe insertion and replacement of balloon and button gastrostomies has been produced by the National Nurses Nutrition Group, the Patient Safety Agency and manufacturers, but standardised national guidelines are required.