Gravity vs. Pump Feeding

[grtchnk]

Jorie has been on essentially the same feeding schedule for the last 3 years - she takes no nutrition orally and all her feeds currently run through the pump. She gets 4 daytime feeds of 150 mls over 45 mins and a continuous night feed for 8 hours.

Recently the rechargable battery on our crappy home pump bit the dust, so we have to have it plugged in to use it, which is tremendously inconvenient. I have the DME sending me a new one, so its not really an issue, but over the weekend while I was waiting for the new pump I decided to do her daytime feeds by gravity....and she was FINE. No excess gas, or any perceptible discomfort.. and she got the feeds in 10-15 minutes, total. I figure since she has grown significantly over the last 2 years and the volume hasn't really changed, the gravity feeds shouldn't be a problem.

Looking for advice on what to look for to see if she is better off getting the bolus feeds through the pump over a longer period of time - or if she can truly handle them by gravity no problem. She has a partial nissan, so she can throw up, but she has never had major vomiting issues, and I saw none this weekend.

Of course the nurses can't switch to gravity unless we get a Dr order, and I'm not sure what the GI/Nutritionists's reaction will be. Any guidance?

[kadiera]

Our nutritionist prefers gravity feeds if the child tolerates them.

[Cillian's Mom]

We switched our daytime feeds for Cillian to bolus slow push feeds and he does fine. We do 120 ml's 4 x day of Blended Diet and we slow push 30 cc's every 15 min. Its nice because we are trying to cut out some small amounts now to see if he understands being "hungry" and asking for food. So far, he will ask for food, but will still only eat the pureed stuff. He will put solids in his mouth, but that's it. Good Luck!!!

[tbhartman]

We split his feeding into 1/3's, used to into 1/4's and gave it every 15 minutes by syringe (over a minute or two). So, it's sort of a mix. Maybe start there, and see if you can get it closer together.

[grtchnk]

Is pushing through a syringe better than hanging the feed by gravity? Obviously you can control the timing a little better that way...

[tbhartman]

Less hassle is my big reason :) Honestly, some love the pump to do everything, fast or slow. Personally, i go crazy and only use it at night. He's so mobile it's easier to have him still a few (less then 3) minutes at a time, every 15 min than to have him in one spot. That being said, i'm more conservative while he's napping, since he's laying down.

[kadiera]

We never used Alexander's pump - a straight gravity feed was less time than setting up the pump.

With Bethany we're a bit more conservative, and give her bolus in 3 parts, 15 minutes or so apart, venting before each part. Feeding that same feeding on a pump over an hour gets us instant puking, because we haven't gotten the air out of her belly.

[Bradley's Mom]

We had a similar situation. Bradley's pump broke on Christmas Eve so we did the gravity feeds until we got a new one. He did great on them so we kept his day feeds as gravity and he still gets a night feed with the pump. It's so much nicer to not have him hooked up to the pump when hes up during the day. All his doc's were OK with it as long as he was tolerating it :)

[drct1245]

...

Of course the nurses can't switch to gravity unless we get a Dr order, and I'm not sure what the GI/Nutritionists's reaction will be. Any guidance?

Ayden couldn't tolerate gravity, so that is why we never did. He only tolerated 30cc of water max at a time, otherwise it would come back to us. :) Now he can tolerate much more and we did bolus feeding where we push via syringe instead of gravity. So I would say, if she tolerates it, why not. The only thing you might need to watch, is should she get a cold, you may have to slow down.

Any nurses cannot switch to gravity, but why can't you as a family switch? There is no need for Drs order, if you don't have nurses. (we switched from pediasure to a BD without any Dr approvals) :)

[Ainsley's Mom]

We use gravity for formula or a syringe for the BD because it's usually too thick to gravity feed. We did a lot of testing because of Ainsley's vomiting, and she was on continuous, then was gradually switched over to pump boluses, then gravity. This was all a LONG time ago. In fact I recall that she actually seemed a bit better doing gravity boluses than with the pump was a bit surprising. Since it didn't cause any problems and she tolerated it, we switched. I also didn't want to be feeding during sleep. And I was SO happy to be free of machines. It also cuts back on the medical waste not having to use bags.

I think if you tried it and it appears to work for Jorie then there is no problem. Personally I didn't like "hanging a bag". I couldn't figure out how to make it work since it has to be higher than the stomach and we always wanted Ainsley to be able to eat at the table. It might be a good idea to try different methods on your own before you get the orders and have the nurses switch.

[IzzyB]

We switched to gravity back in December. His reflux reduced and now is gone. He is still on meds for reflux, but I am thinking about cutting those down in a couple months. So for us gravity was way better. We do 60cc over a couple minutes, wait a half hour and then do the rest of his feed (between 60 - 80cc). We do this every 4 hours even through the night. If he tolerated gravity better I saw no reason to do continuous over night. Now it took us awhile to go from continuous to every 4 hours. We are playing with his new blended diet to get it perfected and then once the puking is gone (right now sometimes trialing new foods does not go well) then we will look to just feed him his whole feed every 4 hours and then look to cut out the night time feeding and eventually go to four feedings a day during the day. But we are far off of that because we do have some puking issues to get through, but the blended diet has really cut down on the amount of times he pukes.

We gave up our pump about a month ago and I don't plan on ever considering it again. It is just so much easier to feed him over a couple minutes vs. hooking him up to a pump. Plus we are on the move on the weekends and a pump is more equipment and just overall more of a pain.