The words lavage and gavage are terms for two different medical procedures. The former refers to therapeutic irrigation or washing of a hollow organ. For example, gastric lavage involves placing a tube through the mouth or nose into the stomach so that toxins can be removed by flushing a saline solution in, and then suctioning out, the gastric contents.
Gavage, on the other hand, refers to force-feeding a person or animal without their consent by supplying nutrition via a feeding tube through the nose or the mouth into the stomach. Sometimes the tube is placed through a small cut in the abdomen. The food provided to the patient consists of what they need for nutrition.
Somehow, to my ear, the French term gavage sounds less aggressive than the common terms tube, or force, feeding. It’s often used when a person or animal is unable to eat and drink on their own, which is no surprise as I doubt there would be many volunteers for the procedure. I’m just happy as a chicken owner that I’ve never had to employ the procedure, regardless of my good intentions to help one of my birds. It’s not something that you should attempt without some training about proper technique, contraindications and how to avoid mistakes.
First of all, it’s important to understand basic anatomy. Chickens, like us, have two tube-like structures in their neck: the trachea, or windpipe, that carries oxygen into, and carbon dioxide out of, the lungs; and the esophagus, a muscular tube connecting the mouth to the stomach (or in chickens their crop). A feeding tube, therefore, needs to enter through the mouth and be worked down the esophagus until it enters the crop. Many species have an epiglottis, a flap that lies over the opening to the trachea, that functions to protect the airway. Birds, including chickens, don’t have one which puts them at risk of aspiration.
When To Tube Feed
- Crop feeding is the main way to provide nutritional support to sick birds that aren’t eating or drinking on their own. It’s the last resort for birds that are severely underweight or dehydrated.
- Tubing: The size of tube required is dependent on the size of the bird: Red Rubber Catheter, 12 French size for large fowl and 10 French for bantams. Red Rubber Catheters can be obtained from a veterinary office or farm supply store in the livestock health section. In a pinch, some folks use air hose tubing from an aquarium supply store, but soft rubber is the preferred material.
- 60ml catheter tip syringe is ideal, also available from farm or veterinary supply stores. Pharmacies usually only carry up to 20ml syringes and most of the time they don’t have catheter (i.e. long, narrow) tips.
- Weigh scale
- Liquefied feed: Avian Health Shake, Omnivore Care, Kaytee Exact, or non-lay crumbles. The feed comes in powdered form which is mixed with water. If it’s unavailable substitute baby food, preferably puréed chicken, mixed with a bit of warm water to make it easier to get through the tube. If there isn’t sufficient protein ground mealworms or crickets can be added. If you store the feed in your freezer it stays fresh for an extended period of time.
- Headlamp or small LED flashlight
Almost all sick birds will be dehydrated, so deal with that first: give warmed (39C/102F) electolytes at 14 ml per pound of body weight, then wait 60-90 minutes and repeat. If no poop is produced after three hours of the first tubing, repeat once more.
When crop feeding a bird, calculate the volume to be fed at 30ml per 1 kilo/2.2 lbs body weight every six-eight hours for adults. Juveniles are fed 10% of their body weight several times a day. Always check the crop first for food contents or decreased crop movement before feeding.
Weigh the bird each morning to monitor weight gain.
Estimated crop volume is 50 ml/kg. Begin feeding one-third to one-half of crop volume.
Most birds are tube fed between two to four times daily.
Calculating Portion Size
Follow the product directions for dosage amount. If you are using pureed baby food or non-layer crumbles then use 14 ml of feed per pound of the patient’s body weight and increase a little at each feeding. Do not exceed 23 ml per pound of body weight.
“The amount to feed can be a bit tricky: it is partly dependent on how much the bird weighs as well as how many calories a feeding is able to deliver. I have always had at least some veterinary guidance on how much to give. Amethyst was around 3 kgs/9.8 lbs at the time I was tube feeding her and I was instructed to give her 60ml of the liquefied Omnivore Care diet three times per day. As she began eating little bits on her own, we first reduced the amount at each feeding, and then we reduced the number of total feedings per day. It was a battle between making sure she was getting enough to maintain her weight, but also avoid her being so full that she wouldn’t try to eat on her own.” – Seleta
“A standard chicken about 2.7 kg/6 lbs is usually 60-80 mls per feeding. I tend to stay closer to 60 ml and feed more frequently. Basically checking by eye on things moving through the crop and feed when it’s empty. “ – Anna
- Measure the distance from your bird’s mouth to her crop and add 2”, then cut a piece from the roll of tubing. Smooth the end that you’ll be putting down her throat to ensure there are no sharp edges. Mark the distance from mouth-to-crop on the tube so you know when you’ve put it in far enough.
- Do a test run (not on your bird) with the feed mix: fill your syringe, attach the tube on one end, depress syringe plunger and ensure that there is a tight seal. If the feed gets stuck add more water to the mix.
- Weigh your bird in order to calculate the appropriate serving size.
Although the actual tube feeding can be done by one person, teamwork makes things easier on everyone. There are online videos of the procedure which you can study before attempting it for the first time.
- Formula should be mixed with water to an appropriate thickness and given warm at a temperature between 37.7- 39C/100˚-102˚F.
- Draw liquefied feed into the syringe. Expel air bubbles which can cause regurgitation.
- Place the patient on your lap or a tabletop in a well-lit area. Swaddle bird in a towel to prevent them from struggling while avoiding wrapping too tightly which can constrict their air sacs and cause respiratory distress. It also may be more difficult for you to feel the bird’s crop for the tube.
- Stretch the bird’s neck up while holding the mouth open.
- Locate the trachea (breathing tube) at the base of the tongue (you want to avoid getting liquids in there) and the esophagus at the very back on the right hand side.
- Slide the tube into the esophagus, not the trachea which feels like a soft straw. Locate the trachea in the neck so as the tube slides down the esophagus you can feel the feeding tube next to it. If you are not certain that you are in the esophagus, do not depress the plunger. If you are in the esophagus, you can usually see the tube moving down underneath the skin and feathers on the neck. Have some patience here, you may have to let them close their mouth and then re-open it several times. If you are facing the bird, angle the tube from right to left into the crop. Stop if you meet resistance.
- Feel for the end of the tube in the crop, then depress the plunger slowly and make sure that the liquid is not backing up into the mouth and down the trachea. Keep the neck and head stretched upwards while the tube in the esophagus.
- Ideally you will have a large syringe that holds a full dosage. If you are using two smaller syringes do not remove the tube; simply detach the first syringe, kink the tube to avoid the introduction of air and use the second syringe once filled. Give in the same manner as the first serving.
- Keep checking the crop to be sure you’re not overfilling and watching the throat, again, for food coming up. If it does, immediately remove the tube, allow some of the liquid to drain (for just a second), then hold the bird’s head up to allow the food to drain in to the crop, otherwise they can aspirate and die. Do not leave the bird’s head down for long as the food will continue to drain, not allowing her to breathe.
- Once you’ve given all the food, remove the tube, pinching the end of it to keep it from leaking as it’s being pulled out.
- Allow the bird to sit quietly for several minutes and avoid touching their crop. Return the bird to the infirmary, making sure not to tip their body forward.
- Don’t use on a chicken that is unconscious, hypothermic or has an obstruction in the digestive tract
- Crop burns can happen at temperatures over 37.7-39 C/100 -102F and may not be seen for several days. Symptoms include: decreased appetite and drooling. If severe, a fistula will open.
- Don’t use a microwave to warm anything being put into the tube to avoid burns. Very warm tap water is usually sufficient to make a food slurry.
- Make sure the bird does not regurgitate. If it does, stop gavage feeding.
- Aspiration is more likely to happen if the bird is stressed causing increased respiration and inhalation of formula. Monitor the bird for further respiratory signs and adjust technique or amount at next feeding.
- The tubing can wear out. Replace as required.
- After repeated uses, syringes get stiff and hard to pull or push the plunger. If you rub some cooking oil on the sides of the plunger, it will go back to working smoothly.
- Hold firmly to the end of the tubing; I’ve heard of cases where a bird swallows it.
Many thanks to Seleta Nothnagel and Anna Whitman for reviewing my first draft and adding comments and suggestions based on their firsthand experience.
Gavage photos courtesy of Seleta and her hen, Amethyst. Featured photo: Nature
Excellent article on tube feeding. A few additional comments:
1) Be careful using Gatorade or Pedialyte. Many varieties contain artificial sweeteners. Many chickens have died after being given these products because of the artificial sweeteners. Check the ingredients, and only use sugar-sweetened or unsweetened versions. Check each bottle that you use, as companies change formulations regularly.
2) If at all possible, have an assistant hold the bird for you so that you can concentrate on the procedure and not the restraint. I have tube fed chickens hundreds of times, and I can do it without help, but it’s significantly more difficult. A beginner will have lots of difficulty if they have to do all these steps AND hold the bird still.
3) The french sizing chart that is included in the article is the interior diameter of the tube, and does not include the wall thickness of the tube itself. The tube will look larger than the dot that is on the chart.
4) Buy a minimum of 3 tubes and 6 syringes. Stuff happens. Been there!
5) Before inserting tube, stretch out chicken’s neck, hold the tube beside the neck, and mark the distance between the center of the crop and the tip of the beak. That’s the distance that you insert the tube. Using a Sharpie, or a piece of tape, mark that distance on the tube.
6) Apply a very thin layer of plain KY jelly from the tip of the tube to about 1/3 – 1/2 of the length. Use real KY jelly, which is water soluble and won’t damage anything if you get a little bit into an airway. Do not use Vaseline, or any oil-based lubricant. I make sure that there isn’t too much KY on the tube by putting a 1-2″ blob of it on a paper towel, put the paper towel in my hand where the jelly is, put the tube in the KY at the 1/2 way mark, close my hand around everything and pull the tube through the lubricant. That gets just the right amount on there without having any large globs that could accumulate in the mouth.
7) I like having one syringe of plain water and one syringe of the tube feeding formula drawn up.
8) To minimize the chance of getting the tube into the trachea (windpipe), do not push the tube straight down the back of the throat to start. Aim from the left side of the birds mouth, across the tongue, into the right side of the back of the throat. The opening of the trachea is in the center of the throat, so with this technique it is very difficult to get into the trachea. Then watch the tube go down the right side of the bird’s neck until you’ve pushed it down to the mark that you’ve put on the tube (see #5 above).
9) Infuse about 5-10 ml of plain water. If you’re in the lungs, the bird will become distressed and cough frantically (unless it’s so sick that it’s almost unreactive to anything). Then change syringes and infuse the tube feeding formula, then followed by enough water to push all the formula out of the tube (you will know because the formula is harder to push through than the water). Then fold the tube to crimp it and pull out of the bird’s mouth.
10) This was already mentioned, but for emphasis, DO NOT handle the crop right after tube feeding. This can easily cause the bird to regurgitate and aspirate.
11) Clean the tube and syringe very quickly after using, ideally within the first 10 minutes. The tube feeding formula can be difficult to get out if left for a few hours, and it can ruin the rubber stopper on the syringe plunger. I clean everything with vegetable wash diluted in water, using the syringe to push it repeatedly through the tube until it is super clean before rinsing. The whirl the tube from one end to spin out any water and hang it to dry. Pull the plunger out of the syringe to allow it to dry.
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Your comments are much appreciated. I will try to work some of them into the body of the article in case they get missed.