A gastrostomy, creation of a gastrocutaneous fistulous tract, may be Indicated for the pediatric patient with a functional gastrointestinal tract who Is unwilling or unable to consume sufficient nutrition to meet caloric needs for optimal growth and development. A gastrostomy may also be used for medication administration, decompression, or access. Several pediatric conditions or anomalies may necessitate gastrostomy. Traditionally, a silicone catheter with a mushroom tip was placed through a gastrostomy. Recently, however, alternative gastrostomy devices have become available. The MIC-KEY device (Medical Innovations Corporation, Milpitas, Calif.) Is one such device. This article Introduces the ET nurse to the MIC-KEY device as an option and discusses Its advantages and disadvantages In the pediatric patient.