Possible cause: Irritation may be due to gastric leakage around the edge of the tube.

What to do:

• Clean the skin site with mild soap and water more often.
• Keep the site dry.
• Use Stomahesive powder and cover it with a dry dressing if needed. If a crust forms from too much powder, soak it off with warm water.
• Diaper rash creams (like zinc oxide) can help.
• Avoid antibiotic ointments unless your child’s doctor prescribes them.
• Call the clinic if it doesn’t improve.

Possible causes: If the G-tube has a balloon, it could be deflated. If it has a mushroom, it may have slipped away from the stomach wall. The stoma hole is larger than the size of the G-tube, which is often due to movement of the tube.

What to do:

• Gently pull back on the tube to ensure it’s snug.

If your child’s care team instructs you to do so:

• Check the amount of water in the balloon. Reinflate with sterile or bottled water.
• Secure the G-tube to decrease movement.
• Make sure the tube is the right size for the stoma hole. Call the clinic if you have concerns.

Possible cause: There could be a clamped tube. Medicine or food could also be blocking the flow.

What to do if the tube is clamped:

• Unclamp the tube.

What to do if there is a blockage in the tube:

• Gently “milk” the tube by rolling it between your fingers.
• Try a brief push with the syringe to start the flow. Never push an entire feeding.
• Thin the formula by warming or adding water if needed (only with dietitian approval).
• Pour carbonated water into the tube, clamp for 10-20 minutes, then flush with warm water.
• Always flush with 5-10 milliliters of water after feeds and medicine. Use less for babies.
• Only use liquid or finely crushed medicines mixed in water.
• If using an extension set, take it off and flush it over the sink.
• Call the clinic if the blockage doesn’t clear.

If your child is on a fluid restriction, a small air flush is okay.

Possible cause: It may be a skin yeast infection caused by moisture or leakage.

What to do:

• Keep the area dry.
• If it doesn’t go away, call your care team.

Your child’s doctor may prescribe medicines like Mycostatin powder or nystatin cream.

Possible cause: This is part of the body’s natural healing process.

What to know:

• This is also known as a granuloma or granulation tissue.
• These are common and not painful.
• It does not mean there’s an infection.
• Call the clinic if you're unsure or want help treating it.

Possible cause: The stoma may be irritated from movement of the tube. Bleeding may occur after a tube change.

What to do:

• Stabilize the tube and tape it well.
• Keep it out of your child’s reach.
• If you see unusual tissue growth or have concerns, call your child’s doctor or nurse. See the “Granulation Tissue” section below for more details.
• Minor bleeding is usually okay. Call the clinic if the bleeding continues.

Possible causes: Many things can cause an infection.

Signs of an infection:

• The skin around the stoma may have a large amount of redness, swelling, and thick or cloudy drainage that isn’t formula.
• Your child may also have a fever.

What to do:

• Call your child’s doctor or clinic right away.

Possible cause: The tube was pulled out, or the balloon broke.

What to know:

• Stay calm. This is not an emergency.
• Important: The tube needs to be replaced within 1-2 hours.

What to do:

• Cover the hole with gauze or a clean washcloth.
• If it's the first tube and hasn’t been changed before, do not try to reinsert it. Call the clinic.
• If the tube has been changed before, you may try reinserting it.
• If the tube has been changed before, and you can’t see the opening, cover it, and call the clinic.
• During office hours, contact the clinic. After hours, go to the Emergency Room.

Granulation tissue is extra pink or red, moist tissue that often grows where the tube exits the skin. It may cause yellow-green drainage or a small amount of bleeding. This is a normal body response, not an infection, and it's not painful.

How to treat granulation tissue:

• Stabilize the tube to prevent movement.
• Clean the site daily with soap and water.
• Let the site air-dry.
• Use a dry dressing if there is drainage. Change it when it's dirty or wet.

How to use Triamcinolone cream:

• Apply a thin layer of cream to the raised tissue using a cotton swab.
• Use three times a day until the raised tissue goes away.
• Do not use longer than two weeks. Call the clinic if there’s no improvement.
• Wait one week between treatments if you need to restart.

Treatment with silver nitrate sticks usually occurs in the clinic. But your child’s care team may also tell you to use them at home.

How to use silver nitrate sticks:

• Apply petroleum jelly, such as Vaseline, around the healthy skin to protect it.
• Touch only the granulation tissue with the medicated end of the stick.
• Use once a day.
• Stop once the tissue dries up or becomes scabbed or scarred.
• Use a split gauze dressing to absorb drainage. Remove after one hour.
• Stop using silver nitrate if the surrounding skin becomes sore or discolored. Call your child’s care team if the skin doesn’t heal.

Skin may darken from drainage or treatment. The stain will go away after stopping the silver nitrate.