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that are fragile In some centers, button devices are placed at the time of the initial gastrostomy Jejunal Tubes Jejunal tubes that pass through the gastrostomy (“GJ” tubes) are usually smalldiameter tubes (8F), an example of which is the Frederick Miller feeding tube set manufactured by Cook (Bloomington, IN) These tubes have a small mercury weight at the distal tip and are placed under fluoroscopy Several types of surgical jejunostomy feeding tubes are available, including Malecot and MIC-KEY jejunal tubes Clinical Findings/Management Complications related to gastrostomy and jejunostomy can be divided into mechanical tube–related problems and problems with the stoma Tube-Related Problems Dislodgment Dislodgment is one of the most common complications of G- and J-tubes This situation may occur as a result of a traumatic event, such as accidental tension on the external tubing, occult balloon deflation, or rupture of the balloon When G-tube dislodgment leads to an ED visit, many parents either recall the size of the tube or bring one along to the ED If neither of these occurs, the patient’s medical record is a helpful resource for locating the most recent tube size The patient with tube dislodgment may present with a benign stoma or with active bleeding related to trauma If the tube size is unknown or if various tube sizes are not available, the most common temporizing method of replacement is insertion of a Foley catheter A crucial consideration is the interval of time since the dislodgment If hours have elapsed, the stoma may be constricted and require insertion of a smaller replacement tube Determining the interval since initial placement of the gastrostomy is important Perioperative displacement (within month of initial placement) is treated differently than dislodgment of a tube from a mature stoma If a recently placed G-tube dislodges, temporary replacement with a smaller Foley catheter may prevent pushing the recently fixed stomach away from the anterior abdominal wall A gastroenterologist or surgeon should then be consulted for definitive care An older tube that has dislodged should be replaced urgently with the same size and type of the tube, if possible, to avoid narrowing of the stoma However, often parents may present several hours after a tube has been dislodged