G-Tube Button

G-Tube Button (Gastrostomy Button) - Complete Practical Guide | PediaDevices

What Is a G-Tube Button?

A G-tube button, also called a gastrostomy button or low-profile gastrostomy device (LPGD), is a small medical device placed through the skin directly into the stomach. It sits almost flat against the abdomen and provides a way to deliver nutrition, fluids, and medications directly into the stomach when normal eating is not possible or not safe.

Unlike a traditional gastrostomy tube (PEG tube) that hangs outside the body, a button device is low-profile and flush with the skin. An extension set is connected to it only when needed for feeding or medication, and removed afterwards.

Quick fact: The G-tube button is one of the most widely used long-term enteral feeding devices in pediatric care worldwide. It is designed for comfort, ease of use, and reduced risk of accidental tube displacement.

Purpose and Where It Is Used

A G-tube button is used when a person cannot take adequate nutrition, fluids, or medications by mouth for a prolonged period. It is placed surgically or endoscopically and is meant for long-term use.

Common Reasons for Placement

Swallowing difficulties (dysphagia) due to neurological conditions
Conditions that cause severe feeding problems from birth (e.g., esophageal atresia, tracheoesophageal fistula)
Chronic illness where caloric needs cannot be met orally (e.g., cystic fibrosis, congenital heart disease)
Failure to thrive with inadequate weight gain despite oral feeding attempts
Head and neck cancers or surgeries affecting the ability to swallow
Neurological conditions such as cerebral palsy, muscular dystrophy, or severe brain injury
Metabolic disorders requiring precise nutrition delivery
Premature infants with underdeveloped swallowing reflexes needing long-term support

Pediatric hospitals Home care settings Rehabilitation centers Long-term care facilities Neonatal units

Types of G-Tube Buttons

There are several types of gastrostomy buttons available. They differ in how they are held in place inside the stomach and in design details.

Type	How It Stays in Place	Key Feature
Balloon-type button	A small water-filled balloon inside the stomach	Easy to replace; most commonly used. Example: MIC-KEY, AMT Mini ONE
Non-balloon (mushroom/dome) button	A soft dome or mushroom-shaped tip inside the stomach	More secure; less likely to fall out accidentally. Requires an obturator for removal. Example: Bard Button
One-piece button	Varies by brand	Simplified design, fewer parts
Two-piece button	Varies by brand	Separate base and anti-reflux valve; allows component replacement

Balloon vs. non-balloon: Balloon buttons are easier to replace at home or in outpatient settings. Non-balloon types tend to last longer and are less prone to spontaneous deflation, but replacement requires more technique.

Sizes

G-tube buttons come in two measurements:

French size (Fr): Refers to the width (diameter) of the tube. Common sizes: 12 Fr, 14 Fr, 16 Fr, 18 Fr, 20 Fr, 24 Fr.
Shaft length (cm): Refers to how long the stem needs to be to pass through the abdominal wall. Correct measurement is important for a good fit.

Size selection is based on age, weight, abdominal wall thickness, and the stoma (opening) diameter. Only a qualified healthcare provider determines the appropriate size.

Parts of the G-Tube Button

Part	Function
Button dome / external base	The part visible on the skin surface; sits flat against the abdomen
Shaft / stem	Passes through the stoma and abdominal wall into the stomach
Internal retention (balloon or dome)	Keeps the device from coming out of the stomach
Anti-reflux valve	One-way valve inside the button that prevents stomach contents from leaking out when not in use
Extension set	Separate tubing attached to the button during feeding or medication administration; detached and stored afterwards
Balloon port (balloon type only)	Small side port used to inflate or deflate the retention balloon with sterile water

How to Use a G-Tube Button: Step-by-Step Guide

The following steps cover the common procedures involved in daily use of a G-tube button. Specific brands may vary slightly; always refer to the instructions provided with the device and guidance from the treating medical team.

A. Preparing for Feeding

Wash hands thoroughly with soap and water for at least 20 seconds before handling the device or any feeding supplies.

Gather all supplies: extension set, syringe, feeding formula or medication, and any clamps or plugs.

Inspect the button site on the skin. Look for redness, swelling, odor, or any leakage before starting. If anything unusual is noted, seek medical advice before proceeding.

Check the balloon (for balloon-type buttons): Use a luer-tip syringe to gently withdraw the water from the balloon port. Note the volume. Re-fill with the exact prescribed amount of sterile water if the volume is lower than recommended. The usual fill volume ranges from 3 to 10 mL depending on device size. Always use sterile water, never saline or air.

B. Connecting the Extension Set

Remove the cap or plug from the button port on the external dome.

Insert the extension set connector into the button with a gentle click or twist (depending on the brand). It should lock securely into place.

Before starting the feed, confirm placement by aspirating (gently pulling back on a syringe) to check for gastric contents (stomach fluid). This confirms the tube is in the stomach.

Flush the extension set with a small amount of water (usually 5-10 mL for children; volume as advised by the healthcare provider) before starting any feed or medication.

C. Administering the Feed

Formula can be given by syringe (bolus feeding), gravity (using a bag and tubing), or via a feeding pump. Use whichever method has been prescribed.

For syringe (bolus) feeding: Fill the syringe with the prescribed amount of formula and allow it to flow in slowly by gravity. Do not push the plunger forcefully.

Keep the person in an upright position (at least 30-45 degrees) during feeding and for at least 30 minutes after, to reduce the risk of reflux and aspiration.

Once the feed is complete, flush again with the prescribed volume of water to clear the extension set.

D. Disconnecting and Storing the Extension Set

Clamp or cap the extension set before disconnecting to prevent air entry or spills.

Disconnect the extension set from the button by reversing the locking motion. Replace the cap or plug on the button dome port immediately.

Rinse the extension set thoroughly with warm water. Wash with mild soap if needed, then air dry. Most extension sets are reusable for a limited number of times (check manufacturer guidelines). Replace as directed, usually every 30 days.

E. Giving Medications Through the Button

Always confirm with the prescribing doctor or pharmacist that a medication can be given via G-tube (not all tablets or capsules are safe to crush).
Give each medication separately, flushing with water between each one.
Do not mix medications with formula unless specifically advised.
Flush thoroughly before and after medication administration.

F. Stoma Site Care (Daily)

Clean around the button base daily with mild soap and warm water using a soft cloth or gauze. Move the button slightly to clean underneath if the stoma is well-healed (as advised by the healthcare provider).

Rinse the area thoroughly and pat dry. Moisture left under the button can cause skin breakdown or infection.

A gauze pad may be placed under the button if there is any leakage or moisture, but change it at least twice daily.

Once the stoma is fully healed (usually after the initial weeks post-insertion), a gauze pad is not routinely needed.

Button Replacement

G-tube buttons are not permanent. They need periodic replacement - typically every 3 to 6 months for balloon-type buttons, and longer for non-balloon types. Replacement is also needed if the button is accidentally removed, the balloon deflates, the valve stops working, or there is damage to the device.

Important: A stoma (the skin opening) can begin to close within a few hours after accidental button removal. If the button falls out, a healthcare provider should be contacted immediately. Some medical teams provide guidance on emergency reinsertion using a spare button or a clean catheter to keep the tract open - follow only the specific instructions given by the treating team.

Planned Replacement - General Steps (Balloon Type)

Confirm replacement size with the medical team before ordering a new device.
Deflate the balloon fully by removing all water using a syringe at the balloon port.
Gently pull the old button straight out in one smooth motion.
Insert the new button using the provided obturator or stylet to guide it into the stoma.
Inflate the new balloon with the prescribed volume of sterile water.
Gently pull the button back until the balloon is resting against the stomach wall.
Confirm placement by aspirating or flushing with water.

Always keep a spare button of the correct size and type available. This is a standard recommendation from most gastroenterology and surgery teams managing G-tube patients.

Precautions and Potential Complications

Like any medical device, a G-tube button can be associated with complications. Recognizing problems early is important.

Problem	Signs to Watch For	Action
Stoma infection (granuloma / wound infection)	Redness, swelling, warmth, pus, foul smell around the site, fever	Seek medical evaluation promptly
Leakage around the button	Stomach contents leaking around the base of the button	Check balloon volume; notify the medical team. May indicate stoma widening or wrong size
Granulation tissue	Raised, pink, moist overgrowth of tissue around the stoma	Report to the medical team for treatment
Accidental decannulation (button falls out)	Button is no longer in the stoma	Keep the stoma open with a spare button or catheter (if trained to do so); contact the medical team immediately
Blocked button or extension set	Resistance during feeding or flushing	Try warm water flush. If blockage persists, seek medical advice. Do not force.
Balloon rupture or deflation	Button moves loosely; can be pulled out easily	Replace the button promptly with the correct size
Buried bumper syndrome	Button becomes fixed, skin grows over the button base	Surgical removal needed; do not pull forcibly. Rare with properly fitted buttons.
Aspiration	Coughing, choking, breathing difficulty during or after feeds	Stop feeding; seek medical help immediately
Skin breakdown (maceration)	Skin around the stoma appears raw, wet, or red	Keep the area dry; consult the medical team for appropriate barrier products

Seek emergency medical care immediately if: there is severe pain at the site, high fever, vomiting through the mouth after tube feeds, abdomen appears distended or hard, tube feeds are going into the abdomen (not the stomach), or there are signs of breathing difficulty after a feed.

General Precautions

Never use forceful pressure to insert or remove the button.
Always confirm placement before every feed using the aspiration or water flush method.
Do not use hydrogen peroxide or alcohol to clean the stoma unless specifically directed by the medical team (these can damage healing tissue).
Keep the balloon inflated with the correct volume at all times; check weekly.
Do not use saline or tap water to fill the balloon - use only sterile water.
Ensure the extension set is fully secured and locked before starting any feed.
Avoid pulling or putting tension on the button during daily activities.

Activity, Bathing, and Daily Life

Bathing: Once the stoma is well-healed (usually after 4-6 weeks post-insertion), showering and bathing are generally allowed. Brief immersion in water (such as a bath) is usually acceptable. Deep or prolonged submersion (e.g., swimming pools, lakes) should be discussed with the medical team regarding safety and infection precautions.
Clothing: Loose-fitting clothing over the site reduces friction and irritation. Some people use soft button pads or covers for comfort.
Physical activity: Most routine activities are safe. Contact sports or activities with risk of the device being hit directly should be discussed with the treating team.
Travel: Always carry extra supplies including a spare button, extension set, syringes, and sterile water. Medical documentation about the device is useful when traveling internationally or through security checkpoints.

Frequently Asked Questions (FAQ)

How is a G-tube button different from a PEG tube?

A PEG (Percutaneous Endoscopic Gastrostomy) tube is a long tube that hangs outside the abdomen. A G-tube button is a low-profile version that sits flat against the skin. A G-tube button is often placed after a PEG tube has established the stoma, or it can be placed as the primary device. The button is generally preferred for long-term use because it is less bulky and more discreet.

How often should the balloon be checked?

The balloon volume should be checked at least once a week using a syringe at the balloon port. The volume can reduce gradually over time due to slow leakage through the balloon material. The exact volume to maintain is specified at the time of placement. Never overfill the balloon beyond the prescribed amount.

Can the button button be seen under clothing?

In most cases, no. The button design is low-profile, sitting close to the skin surface. Under regular clothing, it is generally not visible.

What should be done if the button accidentally falls out?

Contact the medical team immediately. The stoma can begin to narrow within hours. If trained to do so, a spare button or clean catheter of similar size may be gently inserted to keep the tract open while arranging urgent medical review. Do not leave the stoma unoccupied for long.

Is it painful to have a G-tube button?

Once the stoma has healed, most people experience little to no discomfort from the button itself. Some discomfort can occur during replacement or if there is a complication like infection or granulation tissue. Persistent pain should always be evaluated by a healthcare provider.

How long can a G-tube button stay in place?

Balloon-type buttons are generally replaced every 3 to 6 months. Non-balloon (mushroom/dome) types may last longer - up to 6 to 12 months. The exact replacement schedule depends on the brand, condition of the device, and the recommendations of the medical team.

Can any formula or food be given through the button?

Only commercially prepared enteral formulas or blended diets approved by the treating dietitian should be used. Homemade blended foods can be used in some cases if specifically guided by a nutrition team, as these can vary greatly and may block the tube if not prepared and strained correctly.

What if the button is not rotating or feels stiff?

After the stoma is healed, rotating the button gently during cleaning is generally recommended to prevent sticking. If the button feels stuck, does not move, or if the skin appears to be growing over it, seek medical evaluation. Do not force rotation.

Is it safe to give all medications through a G-tube button?

Not all medications are suitable for G-tube administration. Enteric-coated tablets (meant to dissolve in the intestine), slow-release capsules, and some liquid preparations may be unsafe or ineffective when given through a G-tube. Always confirm with a pharmacist or prescribing doctor before crushing or giving any medication via the tube.

How is a G-tube button placed?

Placement is a medical procedure performed in a hospital setting. It can be done endoscopically (PEG), surgically (open or laparoscopic), or using radiological guidance. The method chosen depends on the individual's condition, age, and anatomy. Initial placement requires general or sedation anesthesia in most cases. Button replacement in an established, well-healed stoma is a much simpler procedure.

How to Keep the Device Safe

Storage and Handling

Store spare buttons in a clean, dry place away from direct sunlight and heat.
Check expiry dates on packaged devices before use.
Keep the device in its original packaging until ready to use.
Do not use a device that appears damaged, discolored, or has a compromised packaging seal.

Maintaining the Placed Button

Keep the anti-reflux valve clean; replace the button if the valve no longer closes properly (indicated by leakage from the port when not feeding).
Flush the button with water after every feed and medication to prevent blockages.
Rotate the button gently after the stoma is healed to prevent it from adhering to surrounding tissue.
Inspect the external disc for cracks or wear at each use.

Keep a G-tube emergency kit at home: spare button (correct size and type), extra extension sets, 10 mL and 60 mL syringes, sterile water, clean gauze, tape, and the medical team's emergency contact number.

Infection Prevention

Always wash hands before and after handling the device or the stoma site.
Use clean technique for feeding; sterile technique is required only during placement or in specific clinical situations as advised.
Clean the stoma site daily.
Do not share feeding supplies between individuals.
Discard prepared formula after the time specified by the manufacturer or the nutrition team (usually 4-8 hours at room temperature; 24-48 hours if refrigerated).

Follow-Up and Monitoring

Regular follow-up with the treating medical team is important for anyone with a G-tube button. Typical follow-up visits involve checking the stoma, reviewing nutrition and growth, confirming correct button size, and addressing any concerns. The frequency of follow-up varies based on the underlying condition and stability of the feeding plan.

Routine stoma checks and measurement of the stoma tract may be performed to ensure the button size remains appropriate as the person grows or weight changes.
Nutritional status is monitored regularly through clinical assessment and, where needed, laboratory investigations.
Device replacement schedules are reviewed at follow-up appointments.

Suggested References for Further Reading

Corkins MR (ed). The A.S.P.E.N. Pediatric Nutrition Support Core Curriculum. American Society for Parenteral and Enteral Nutrition.
Baker SS, Baker RD, Davis AM (eds). Pediatric Nutrition Support. Jones and Bartlett Publishers.
World Gastroenterology Organisation (WGO) Practice Guidelines on Enteral Nutrition: www.worldgastroenterology.org
American Society for Parenteral and Enteral Nutrition (ASPEN): www.nutritioncare.org
European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN): www.espghan.org
Manufacturer clinical resources: MIC-KEY (Avanos), AMT Mini ONE (Applied Medical Technology), Bard Button (BD)

Medical Disclaimer This content is intended for general informational and educational purposes only. It does not constitute medical advice, diagnosis, or a treatment plan. Information about G-tube buttons and gastrostomy care can vary by device brand, patient condition, and institutional protocols. All decisions regarding placement, use, maintenance, troubleshooting, and replacement of a G-tube button must be made by qualified healthcare professionals based on the individual clinical situation. Do not use this guide as a substitute for instruction from the treating medical team. In an emergency involving a feeding device, seek immediate medical care.

Content reviewed by a practicing Pediatrician. Last reviewed: May 2025.

Labels: GIT-System

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