&NA;Low‐profile gastrostomy replacement devices (LPGRDs), also called gastrostomy buttons, provide patients with a desirable alternative to traditional catheters. Contraindications to LPGRDs include acutely angled gastrostomy tracts, tracts created with a mucosa lining, the need for jejunal feedings or significant decompression, planned retroesophageal dilation and tracts that are longer than the LPGRDs. Gastrostomy and patient considerations lead to a variety of scheduling practices. Management adaptations help maintain LPGRD patency and functioning of the anti‐reflux valve and plug. Other adaptations are necessary for patients receiving thickened feedings or medications per gastrostomy, needing intermittent decompression or having high intra‐abdominal pressure. Determining the correct LPGRD size and dilating the tract or cauterizing conclude this discussion which is summarized in a checklist following the text.