Nasogastric tube feeding

What is a nasogastric tube feeding? by the doctor and dietitian, depending on

your child’s needs.
A nasogastric (NG) tube is a small tube that Follow only the checked instructions in this
goes into the stomach through the nose. sheet.
Breast milk, formula, or liquid food is given
through the tube directly into the stomach,
Your child’s special instructions:
giving your child extra calories. Feeding this
way helps your child get enough nutrition to Type and size of feeding tube
grow, develop, recover from illness, play, ___________________________________
and learn. Change the feeding tube every ________
Do not change the feeding tube yourself.
What to feed ________________________
Amount to feed ______________________
How often to feed ___________________
esophagus Method: bolus continuous
trachea Type of pump _______________________
lung Rate of feeding ______________________
____________________________________
intestines stomach Flush the feeding tube at the end of each
start here
feeding with ______ ml of warm water.
Other:______________________________
Tube feeding can be done for children of Care of feeding bag and tubing:
any age. Some children will depend on tube
Change every day.
feeding only until they are able to eat by
mouth. Using the gastrointestinal (GI) tract After each use, wash with warm water
for feedings keeps it healthy and working and dish soap, rinse well with clear water,
normally. and store in refrigerator.
If the bag and tubing do not clean easily, try
Other children can continue to eat as usual,
using a solution made of equal amounts of
and also get tube feedings for extra calories.
white vinegar and cool water (for example 1
There are several ways to give an NG cup vinegar with 1 cup water). Rinse well
feeding. The type of tube, how often it needs and store in refrigerator. Throw away the
to be changed, type and amount of formula, feeding bag and tubing after 1 week; sooner
and length of feeding time will be decided if you cannot get it clean or if it begins to
leak.

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Definitions 5. Using a tape measure, measure from the
tip of your child’s nose to the bottom of
aspiration getting fluid into the lungs, the earlobe, then down to that spot
which can cause trouble midway between belly button and
breathing breastbone edge. Write that number
bolus feeding over a short time down: we will call it “your child’s
measurement.”
continuous feeding over an extended time
GI tract the esophagus, stomach, and In this picture, the child’s measurement
intestines is 12 inches (3 inches from nose to ear,
gavage tube another name for feeding plus another 9 inches down.).
tube; may be put in through
mouth
lubricant water-soluble substance such
as K-Y® jelly, used to help the
tube slip in more easily -
do not use Vaseline® ®

Inserting the feeding tube sternum

(breastbone)
It takes time and practice to learn how to
insert the tube, so be patient with yourself.
Do this by yourself only after you have done
it successfully with the nurse present. bottom of
belly button rib cage

Get ready: Measuring your child

(this child’s measurement is 12 inches)
1. Wash your hands.

2. Gather supplies:
6. Now measure the tube (or find its length
• feeding tube on the package it came in). Subtract your
• tape measure child’s measurement from the total tube
length, and write it down, too. We will
3. With your fingers, find your child’s call this the “extra tube length” number.
sternum (breastbone). Gently feel the Keep it handy; you will use it later to
bone in the center of the chest, and then make sure the tube is placed properly.
find its bottom edge. It will be below
nipple level, and you will feel the bottom 7. Now, from the tip of the tube, measure
of the rib cage curving away to each the distance of your child’s measurement
side. (in the pictured example this would be
12 inches). Mark that spot on the tube
4. Now imagine a spot on your child’s
using a permanent marker. Now you are
belly that is midway between the belly
ready to insert the feeding tube.
button and the bottom edge of the
breastbone. Keep that spot in mind.

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Insert the tube: Remove the tube right away if:
• coughing
1. Wash your hands. • wheezing
• changing color
2. Gather equipment:
• cannot catch a breath
• feeding tube
• cannot talk
• formula
• or you see the tube coming out of the
• gauze if needed
mouth
• water for lubrication or other
lubricant Cuddle and comfort your child for a few
• stethoscope minutes, and try again.
• syringe, size _________________
6. Once the tube is in place, secure it with
• tape, type ___________________
tape as shown by the nurse.
• water for rinsing if needed
7. Check the tube placement (see below).
3. Position the child.
Swaddle an infant (wrap with the Checking the tube placement
arms secured in a blanket). Put the infant
on the left side, either in an infant seat or To prevent aspiration, you must check the
on a bed, with the head raised. tube placement before each feeding, to be
sure it has not moved.
Older children should be placed in a
comfortable position, and may be held 1. Look at your child. Is your child
by an adult if they wish. Some children comfortable and breathing normally? If
may vomit when the tube is put in. Be the child appears distressed, is coughing,
sure the child can be turned easily if this or cannot talk, remove the tube. Do not
happens. start the feeding.
4. Lubricate the tube with water or put a 2. Make sure that the mark on the tube is at
small amount of lubricant on the end of the nostril. Measure the tube from the
the tube if you have been taught to do so. mark at the nostril to the beginning of
Most tubes have a coating that is the hub and make sure it matches the
activated with water, making the tube “extra tube length” number you wrote
easier to slide in. down earlier. (See “Get ready,” step 7,
on page 2.)
5. Insert the tube into the nostril, pushing
the tube gently down until the mark on 3. Try to pull out some stomach fluids with
the tube is at the tip of the nose. Older the syringe. Using a small syringe (3 to 5
children can drink or swallow to help the ml) will make this easier. If you do get
tube go down. Infants may suck on a stomach fluids, push them back into the
pacifier or your fingers during tube tube. Note: With a 3.5 or smaller
insertion. This can be uncomfortable for “neotube” you may not be able to pull
your child. It may be best to have out stomach fluids.
someone help you.

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4. Use a syringe to inject ____ ml of air 9. Ways to help the feeding flow:
rapidly into the feeding tube while Try to start the feeding when the child is
listening with a stethoscope over your calm. You may have to “push” the
child’s stomach. If you hear a “gurgling” feeding to get it started. To do this, place
or “swooshing” sound, the air is a plunger into the syringe and push
probably going into the stomach. Pull slightly. Remove the plunger gently and
the air back out. Note: This test is not allow the formula to flow in by gravity.
100% reliable. Use it only to confirm If your child is crying, you may need to
your other checking methods. Always repeat the push several times.
assess correct placement by measuring A pacifier may help calm a young child
the tube and checking stomach contents. and also helps to connect sucking with
stomach-filling.
Paying careful attention to these signs will
help you to be sure that the tube is placed For older children, use activities to
correctly. If you have any doubts, it is best distract them, or involve the child with
to remove the tube and replace it. the feeding, such as holding the syringe.

Giving the feedings 10. During the feeding, keep the bottom of
the syringe no higher than 6 inches
above the child’s stomach.
Bolus feeding
11. Continue adding formula into the
It may be helpful to have 2 people to do this
syringe until the prescribed amount is
type of tube feeding. One person can hold
given.
and comfort the child while the other gives
the feeding. 12. When the syringe is empty, flush the tube
with the prescribed amount of warm water.
1. Wash your hands.
13. After the feeding:
2. Measure the correct amount of formula
and warm it to the desired temperature. Clamp the tube.
Leave the tube open to air. Tape a piece
3. Check tube placement as above.
of gauze over the syringe to keep fluids
4. Clamp the tube. from splashing out.
Burp your child.
5. Attach a syringe to the feeding tube.
Infants and young children may be most
6. Pour the formula into the syringe. comfortable with their head and upper
body raised, or lying on their left side.
7. Unclamp the tube. Older children may be up and playing.
8. Allow the formula to run for the same
amount of time as it would take the child
to drink it by mouth, or as prescribed by
the doctor.

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 Continuous feeding with a 12. After the feeding period, flush the tube
feeding pump with the prescribed amount of warm
water.
1. Wash your hands.
13. After the feeding:
2. Measure enough formula for 4 hours and Plug or clamp the tube.
warm it if needed.
Leave the tube open to air. Tape a piece
3. Pour formula into the feeding bag. Run of gauze over the syringe to keep fluids
formula to the end of the pump tubing. from splashing out
Burp your child.
4. Set up the pump and pump tubing
according to the directions from the Have child’s head raised for about 30
medical supply company. Be sure the minutes after the feeding is done.
rate is set correctly.
Removing the feeding tube
5. If a new feeding tube is to be inserted, (if ordered)
see “Getting ready to insert the tube”
and “Inserting the tube.” 1. Remove the tape.

6. Check placement (see “Checking the 2. Pinch the tubing and pull the tube out in
tube placement.” one quick motion.

7. Connect the pump tubing to the child’s 3. Hold, cuddle, and comfort your child. If
feeding tube. your child is an infant, burp him or her.

8. Turn on the pump. Check to make sure Skin care

the formula is dripping.
Clean your child’s skin around the tube
9. As the bag empties every 4 hours, add often with warm water, removing any
more formula. secretions. If the nostril is reddened or the
skin is irritated, remove the tube and replace
10. Hold and/or talk to your child often it in the other nostril, if possible.
during waking hours. Have your child’s
head raised during the entire feeding. If you have used a transparent dressing on
your child’s face, remove it by loosening it
11. Watch your child carefully to make sure with mineral oil and gently working the
there is no change in breathing or dressing off. If you use adhesive remover to
behavior. Make sure the mark on the loosen the dressing, be sure to wash the skin
tube is still at the nostril. It is also a good with water to remove all residue, as this can
idea to measure it every few hours, be very irritating.
because sometimes the tube can slip
under the tape.

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 Problem solving
Problem What to do
Clogged or plugged • Flush tube with warm water.
feeding tube (follow only • Use Clog-Zapper® if instructed to do so.
the checked instructions)
• Remove and replace the tube.
Corpak tube falls out • Call the home care nurse or your clinic. Do not replace it yourself.
Coughing while tube is • If your child gags or coughs during the feeding, pinch the tube and
inserted pull it out. Comfort your child until calm, and try again.
(to prevent aspiration) • Before starting the feeding, be sure to check the placement of the
tube (see “Checking the tube placement”).
Diarrhea and cramping • Check to see if the formula concentration is correct.
• Allow formula to hang a maximum of 4 hours. Do not mix new
formula with formula that has been hanging.
• Slow the feeding rate or stop for awhile. Be sure to flush the tube
with warm water to prevent clogging.
• Warm the formula if it is cold.
• Call your child’s doctor if this continues.
Nausea (upset stomach) or • Slow feeding rate or stop feeding for a while. Be sure to flush the
vomiting (throwing up) tube with warm water to prevent clogging.
• Start feeding again when the child feels better.
• Call your child’s doctor if this continues.
Skin around the nose is • Keep the area around the nostrils clean and dry.
irritated • Tape down, not up over the nose (ask the nurse show you how to
tape the tube).
• Alternate nostrils when replacing tube.

When should I call the doctor? Questions?

• fever This sheet is not specific to your child, but

• vomiting or diarrhea that does not stop provides general information. If you have
• fussiness, hard to console any questions, please call your doctor, home
• pain or unusual distension in abdomen care nurse, or dietitian.
• trouble breathing - call 911
Children’s Hospitals and Clinics of Minnesota
If you are concerned about your child for Patient/Family Education
any reason, call your doctor to discuss the 2525 Chicago Avenue South
Minneapolis, MN 55404
symptoms. Last Reviewed 1/2013 Copyright

Nasogastric tube feeding

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