Today was a great day for the Pilegaard family. We returned James' feeding pump! James has had a feeding pump since October 2011 on his discharge from g-tube placement. Back then, it was a lifesaver. We had been doing bolus feeds through NG tube around the clock. It was exhausting. We would wake up every three hours and feed James in a syringe via gravity over about half an hour. When we ended up back in the hospital and the nurses took over it was a lifesaver! We didn't like being in the hospital, of course, but it was the first time we had a full night's sleep in a month. I think the first night we both slept for about nine hours. Now, for many reasons, we prefer to use syringes. Here are the good and bad for each:
Pump Pros:
1. Ease of use
Especially for nighttime feeds, the pump is an answer to prayer! Parents can wake up, plug the line into the g-tube, push start, and go back to sleep. Wonderful! Also great for longer car rides when it would be very difficult to do syringe feeds without stopping for an extended period of time.
2. Singularity
The feed bags that connect to the pumps are good for 24 hours before you have to worry about bacteria build up. That means, if you want to, you could technically put all of your child's food into the bag in the morning, program the pump for how much you want for each feed, and you are done with food for the day! (Although, disclaimer, this is not recommended. We, however, would do this because every time we tried to prime our pump with water to clean it between feeds our bags would break. We decided that we would rather have bags that work.)
3. Portability
Because you can put larger amounts of food in the enteral bag it is easy to carry around your child's nutrients for the day. Ours would easily fit in our diaper bag even when the bag was full. No coolers to worry about!
4. Calorie Counting
The pumps are programmable to dispense the exact amount of liquid you need to get into your child's belly. It is much easier to measure calories when you know your child is getting every last drop!
5. Continuous Feeds
If your child needs to be on continuous feeds this is probably the only way to go but I could be wrong.
Pump Cons:
1. Blended Foods?
It is much more difficult to do blenderized diets through the pump. We had a Kangaroo Joey and didn't even think of putting James' blended food in it. Some people have managed this feat but it takes a lot of straining, resetting the pump, and patience. Some pumps out there are better quality and can handle it but may not be covered by insurance.
2. Leash
If your child is very mobile, the pump may not be for you. James is rolling all over the place (and will, hopefully, be crawling soon) and the pump line became dangerous. I had to be close at hand in case he managed to wrap himself up during his hour-long feed. It was also very easy for him to pull the pump line out of his tube extension, leaving us with a mess.
3. Hanging Bag
Sometimes it can be hard to find a place to hang the feed bag when you are not around an IV pole. We have come up with many ingenious ways to fix this problem (those infant ring links are a life-saver), but it isn't easy!
4. Hunger Association
When the machine comes out, your child sees it, and soon after feels full, it is hard to motivate oral eating. Your child is thinking, "But mom, that thing makes me feels better, why would I use my mouth when I don't want to?" This can happen with the syringe too, but the machine is visible for the entire feed whereas, if you are using a plunger syringe gradually over a period of time, the child only sees the syringe every so often. If you are using a pump try to hide it out of sight (hung behind your child) so you can work on oral skills and hunger association. Keeping it out of sight will be more difficult as your child gets older and more mobile.
5. Connection
We have had a very difficult time with the connection between the tube extension and the machine tubing. The extension port would stretch over time and we would need to use "no more pull-outs" which worked sometimes and other times would need to tape the tubing together. Not ideal. We were, however, using a mix of syringe and pump which tends to stretch the port faster.
Syringe Pros:
1. Blended Diet!!!
This is a big deal to me. Syringes are much more versatile when it comes to foods other than formula and breastmilk. Syringes with plungers that push the food into the tube work great for the thicker blended meals. We give James his feed over an hour (as we would with the pump) but we give him one ounce through the tube every ten minutes.
2. Leash
No leash for your child to get caught up in! I like for James to be able to move around and enjoy himself during the four hours out of the day that he is eating.
3. Normalcy
Your child will not be hooked up to a pump. Isn't it nice to give your child as normal a life as possible? :D
4. Cheaper
I need to check our bills but I am guessing it will be cheaper to get 2 syringes per day than to rent the pump and pole and buy bags each month. This, obviously, is not a reason to change methods unless it will be beneficial for other reasons as well.
Syringe Cons:
1. Messy
Filling the syringes with thicker liquids can get very messy! The pressure and dexterity it takes to work out the air bubbles is difficult to gauge. I have, more than once, ended up with goo all over me or the ceiling or both.
2. Portability
Syringes are by far harder to port around. Most times we carry around a half-pint mason jar (available at Target) filled with James' meal and refill the syringe as necessary. But, as noted above, this can be dangerous, and much more so in public than in the privacy of our own home. We also have to make sure we carry around good hand sanitizer to keep James' meals germ-free. Some syringe brands have caps on them so that you can fill everything at home and uncap and go as needed on the road. I believe the BD brand has this.
3. Car Rides
This is where it gets tricky. If you are squirting a certain amount of food into the g-tube every ten minutes longer car rides can be difficult. You have to work feeds around car trips or stop every so often to refill.
My assessment of the situation is that the pump can be very convenient for younger, less mobile children on breatmilk or formula diets and/or continuous feeds. Syringes, however, are better as the child become more mobile and/or takes a blended diet.
What has been your experience withe feeding pumps and syringes? Do you have tricks up your sleeve that make one or the other easier to use for your child?
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