Pediatric Tube Feeding Considerations

Tube feedings provide nutrition, medications, and water by means of a:

  • Nasogastric (NG) tube (a tube that goes through the nose to the stomach).

  • Nasoduodenal (ND) tube (a tube that goes through the nose to the first part of the small intestine).

  • Gastrostomy tube (GT) (a tube surgically placed through the skin into the stomach).

  • Jejunostomy tube (JT) (a tube surgically placed through the skin into part of the small intestine).

These methods of feeding are most often used for children who have a medical condition that interferes with the way they would otherwise eat. Such illnesses include failure to thrive, stomach or intestinal problems, or difficulty in sucking or swallowing. In some cases, children who require these feeding methods can regain the ability to eat by mouth again.

RISKS AND BENEFITS

Advantages of tube feedings include:

  • Providing adequate nourishment.

  • Prolonging life.

  • Enhancing comfort and quality of life.

Disadvantages of tube feedings include:

  • Risk of aspiration pneumonia (pneumonia caused by breathing food or liquid into the lungs).

  • Diarrhea.

  • The need for restraints.

  • Fluid and electrolyte imbalances.

  • Risk of infection.

NG TUBE INSERTION AND POSITION

Mostly likely, your caregiver has already placed the NG during your child's stay in the hospital. If you are to take your child home with an NG in place, you should be taught how and when to check the position and how to change the tube. Checking the position should be performed prior to every feeding to ensure the tube is not in the lungs or the throat. Checking the NG tube position, as well as NG tube insertion, can be performed at home as followed:

To Check the Position of the NG Tube:

  1. Wash your hands thoroughly with an antibacterial soap. This will help prevent infections.

  2. Gather all needed equipment:

    • A stethoscope.

    • A 5 mL syringe.

  3. Have your child lay back (or swaddle him or her).

  4. Connect the 5 mL syringe of air to the end of the tube. Place the circular portion of the stethoscope over the stomach to listen and insert 5 mLs of air into the tube. A "swoosh" or gurgling sound should be heard over the stomach as the air is injected in, which means the tube is in the correct position.

  5. Pull back on the syringe to remove the 5 mLs of air you just injected (and possibly some stomach contents), and remove the syringe from the tube.

  6. Wash the syringe out with soap and water and let it air dry.

  7. Wash your hands and prepare the feeding as directed.

  8. If you do not hear a "swoosh" or gurgling sounds in the stomach when you check the position of the tube, do not use the tube to feed your child. Advance the tube or insert a new tube as instructed by your caregiver. If you have not received instruction on this or if you continue to have difficulty, call your caregiver immediately.

To Perform NG Tube Insertion:

  1. Wash your hands thoroughly with an antibacterial soap. This will help prevent infections.

  2. Gather all needed equipment:

    • Sterile water.

    • New feeding tube.

    • Stylet (if needed).

    • Stethoscope.

    • Tape.

    • 5 mL syringe.

  3. Have your child lay back (or swaddle him or her). If possible, have an extra person present for assistance.

  4. Measure the tube from the tip of the nose, to the earlobe, then to the middle of the belly between the bottom of the breastbone and the belly button. Use a piece of tape to mark the measurement on the tube. The tube will need to be inserted to this mark for proper placement into the stomach.

  5. Pull up 5 mLs of air into the syringe. Place it aside.

  6. Place the tip of the tube in sterile water if needed to help pass the tube.

  7. Place your child on his or her left side to help pass the tube.

  8. Insert the tip of the tube into the nostril that was not used previously for tube insertion. This will help in preventing breakdown on one side of the nose. However, if your caregiver has stated that you should only use one nostril, follow his or her direction.

  9. Insert the tube until you reach the tape you placed previously. If your child has trouble breathing, has wheezing, turns blue or pale, or you see the tube coming out of the nose or mouth, stop and remove the tube.

  10. Connect the 5 mL syringe of air to the end of the tube. Place the circular portion of the stethoscope over the stomach to listen and insert the 5 mLs of air into the tube. A "swoosh" or gurgling sound should be heard over the stomach as the air is injected. This means the tube is in the correct position. If there is a stylet in the tube, remove it.

  11. Pull back on the syringe to remove the 5 mL of air you just injected (and possibly some stomach contents), and remove the syringe from the tube.

  12. Secure the tube to the side of your child's face using a piece of tape.

  13. Wash the syringe out with soap and water and let it air dry.

  14. Wash your hands and prepare the feeding as directed.

  15. If you do not hear a "swoosh" or gurgling sounds in the stomach when you check the position of the tube, do not use the tube to feed your child. Advance the tube or insert a new tube as instructed by your caregiver. If you have not received instruction on this or if you continue to have difficulty, call your caregiver immediately.

ND TUBE INSERTION AND POSITION

  • Most often ND tubes are placed under visual guidance while your child is in the hospital. An X-ray confirms placement of this tube. It is necessary to check placement before every feeding. To check placement:

  • Attach a 10 mL syringe to the end of tube and pull back to check for stomach contents or bile. Ask your caregiver if there are instances when you would not want to feed your child depending on the amount or type of contents withdrawn from the stomach.

  • Suspect a problem with the ND tube if the tube is difficult to flush or use for feedings. Do no t attempt to force fluids through. Call your caregiver.

  • The ND tube should never be replaced at home because of the risk of putting a hole (perforation) in the intestine. If your child's ND tube falls out, do not attempt to replace it. Call your caregiver.

GT OR JT INSERTION AND POSITION

  • GT or JT tubes are placed surgically. There are instances in which the GT may need to be changed. Your caregiver will let you know when this needs to occur.

  • To check placement prior to feeding, attach a 30 mL syringe to the end of the tube and attempt to withdraw stomach contents. Ask your caregiver if there are instances when you would not want to feed your child depending on the amount or type of contents withdrawn from the stomach.

  • Clean the area around the GT or JT with warm water.

  • If the GT or JT has formula leaking from the insertion site or it falls out, call your caregiver.

ADMINISTRATION OF BOLUS FEEDINGS

  1. Wash hands thoroughly with antibacterial soap. This will help prevent infections.

  2. Measure the formula as directed by your child's caregiver. Warming the formula helps to prevent stomach upset or gas. Warm the formula by placing container it in warm water. Never microwave the formula.

  3. Check tube placement as directed above.

  4. While clamping the tube, attach a large syringe (usually a 60 mL syringe) to the feeding tube, and pour the formula into the syringe. Keep the syringe no more than 6 inches above the stomach during the feeding to prevent the formula from going in too fast.

  5. Let your child sit upright or raise the head of the bed during the feeding and for about 30 minutes after the feeding.

  6. Unclamp the tube and let the formula go into the stomach at the rate directed by your child's caregiver.

  7. Add more formula as directed by your child's caregiver.

  8. After the feeding has finished, slowly flush the tube with 5 to 10 mLs of warm sterile water.

  9. Clamp your child's tube.

  10. If directed, remove the tube by removing the tape from the face, and removing the tube from the nose steadily and quickly.

  11. Burp your child.

ADMINISTRATION OF CONTINUOUS FEEDINGS

  1. Wash hands thoroughly with antibacterial soap. This will help prevent infections.

  2. Measure the amount of formula for 4 hours. Warming the formula helps to prevent stomach upset or gas. Warm the formula by placing the container in warm water. Never microwave the formula.

  3. Check tube placement as directed above .

  4. While disconnected from your child's tube, place 4 hours worth of formula in the feeding pump bag and run the formula through the tubing until it reaches the end of the tubing.

  5. Turn on the pump and program the pump as directed by your child's caregiver. Ensure the pump is running by observing the flow of formula out of the pump tubing.

  6. Pause the pump and connect the pump tubing to your child's feeding tube.

  7. Open any clamps and start the pump.

  8. Let your child sit upright or raise the head of the bed during the feeding and for about 30 minutes after the feeding. Add more formula as prescribed by your child's caregiver.

  9. After the feeding has finished, slowly flush the tube with 5 mLs of warm sterile water.

  10. Close any clamps on your child's tube as directed.

  11. If directed, remove the tube by removing the tape from your child's face and removing the tube from the nose steadily and quickly.

  12. Burp your child.

  13. If your child has a GT or JT, you may need to "vent" the tube by leaving the tube open to air. Your child's caregiver can teach you this technique.

SEEK MEDICAL CARE IF:

  • You child has a fever.

  • Your child has vomiting, diarrhea, or constipation.

  • Your child has prolonged fussiness.

  • Your child has pain.

  • Your child has a bloated or distended abdomen.

  • There is redness, swelling, leakage, sores, or pus around the tube insertion site.

  • The GT or JT falls out.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your child has trouble breathing.

  • You see blood around the tube, in your child's stool, or in contents of the stomach.

  • Your child coughs, chokes, or vomits while feeding.

  • Your child has a rigid, bloated or distended abdomen (abdomen feels hard when gently pressed).