Which of the following is NOT a common cause of reflux in children receiving enteral nutrition?

• A. Spicy foods
• B. Tube migration into the esophagus
• C. Rapid administration of enteral formula
• D. Delayed gastric emptying

Answer: (B)

Reflux in children receiving enteral nutrition is driven mainly by how the stomach handles the feeds and how quickly the contents move or stay in the stomach. When feeds go in too quickly, the sudden rise in gastric volume can overwhelm the pylorus and LES, leading to backflow into the esophagus. When gastric emptying is slow, contents linger in the stomach, increasing pressure and the chance of reflux. Spicy foods can irritate the stomach and esophagus and may worsen symptoms in some kids, but they are not the primary mechanical causes in the tube-fed setting.

The idea of the tube migrating into the esophagus is a positioning issue rather than a typical reflux mechanism. If the tube sits in the esophagus, feeds would bypass the stomach and cause other problems (like irritation or risk of aspiration) rather than producing the usual gastric reflux from a properly placed tube. Because reflux in enteral nutrition is about gastric factors and delivery rate, tube migration into the esophagus is not a common cause of reflux.