Intermittent Nasogastric Feedings
Your child needs a nasogastric tube (NG tube) for feeding. This soft tube has been placed through your child’s nose and down into the stomach. Tube feedings will help your child grow and stay healthy. Your child’s nurse will teach you about the amount and type of feeding needed before discharge.
To feed your child, you will need these supplies:
- Feeding set
- Measuring cup with pouring spout
- Water to flush (clear) the tubing
- Syringes (10 ml or larger)
- Additional supplies to check placement of the NG Tube as advised by your doctor or home health nurse
Feeding your child
- Wash your hands.
- Prepare the formula. Formula that has been opened needs to be kept in the refrigerator. Take out the exact amount that you need from the refrigerator about 30 minutes before the feeding. This will let the formula warm to room temperature. Any opened formula stored in the refrigerator should be thrown out after 24 hours to avoid giving your child spoiled formula.
- Check the temperature of the formula before feeding by putting a few drops of it on your wrist. The formula should feel warm, not hot or cold.
- Close the clamp on the feeding bag. Pour the formula into the bag. If not using a pump, hang the bag high on a hook and squeeze the drip chamber to fill it halfway with formula. Open the clamp so that the formula fills the tubing until there is no more air. Close the clamp.
- Your child’s head must be raised during the NG tube feeding. You can hold your infant in the curve of your arm while feeding (cuddling position). If your child is older, you can feed him/her in a high chair or any seat as long as his/her head is raised. Hang the feeding set on a hook in the room.
- Before each feeding you must check that the NG tube is still in the stomach.
- Compare the length of the exposed tube with the length when it was first inserted. If this length has changed, carefully adjust the tube. (Gently slide the tube in or out to the desired length.)
- Your doctor or home health nurse may advise you to use pH test strips to check stomach contents that are pulled through the tube with a syringe, or to use a stethoscope to listen for air pushed through the tube by a syringe. Your child’s nurse will show you how your child’s doctor wants you to check placement.
- NOTE: If your child has not had a feeding in over 2-3 hours you may not be able to get any stomach contents when you check.
- If you are unable to confirm the tube is in the stomach, you must remove the tube and put it back in or call your doctor or home health nurse.
- Once placement is confirmed, insert the catheter tip of the feeding system into the NG tube.
- The feeding should take the same amount of time as regular feeding or meal, at least 20-30 minutes. If your child cries during the feeding, stop the feeding until he/she is quiet. This can be done by clamping the tube or pinching it with your finger and thumb.
- Eating is a social time so make the feeding a happy time for your child. If your child needs oral stimulation, follow the instructions given to you by your child’s occupational therapist or nurse. Refer to the Way to Grow for Simulated Feedings.
- After the feeding use a syringe to add water and/or air to clear the feeding from the tube. Your child’s nurse will tell you which to use and how much. Then, close the clamp on the NG tube and remove the feeding system.
- Any medicine given through the tube should be finely ground and dissolved, or given as a liquid to prevent a blockage in the tube. Always check tube placement before you give any medicine through the tube. Most medicines should be given before you start the feeding. This helps the body use it better. Flush the tube with 5-10 ml of water before starting the formula. If you are giving a medicine without a feeding to follow, flush the tube with 5-10 ml of water to get the medicine from the tube and into the stomach.
- After each feeding wash the syringe, feeding tube and measuring cup in hot, soapy water. Rinse with hot water and dry. If formula is caked on the syringe or tubing rinse with a carbonated beverage before cleaning. This will help remove dried formula.
- Follow your child’s doctor’s or dietitian’s instructions to make the formula. Never give more or less of the formula volume than your child’s doctor ordered. If you are using concentrated formula add the exact amount of water as instructed by your doctor or dietitian.
- If your child seems hungry after feedings, ask your child’s doctor or dietitian about feeding him/her more. Some children who are fed by an NG tube may be able to take solid foods by mouth. Your child’s doctor, dietitian, occupational therapist or speech therapist will suggest which solid foods and the best way to feed your child.
- If your child’s tube seems to be clogged, place a small amount of a carbonated beverage into the tube and allow 5-10 minutes to break up the clog. Flush with 5-10 ml of water before giving medicine or feeding. If you cannot flush with water because the tube is still clogged, remove it. Put in a new tube or call your child’s doctor or home health nurse.
When to call your doctor or dietitian:
- If diarrhea occurs, lengthen the feeding time by 15-30 minutes. If the problem continues, call your child’s doctor or dietitian. Inform your child’s doctor or dietitian of any changes in your child’s feedings, including any new medicine that was given.
- If your child’s stomach becomes hard and swollen after a feeding, “burping” may help. Attach an empty syringe to the NG tube, raise the tube and unclamp it. This will allow air to escape. Your child’s nurse will show you how to do this. Wait one hour. If the stomach is still hard and swollen and your child acts as if he/she is in pain, call your child’s doctor or the Emergency Room for advice.
- Constipation (hard, dry bowel movements) may become a problem with long-term tube feedings. Check with your child’s doctor if this becomes a problem. Ask about using a formula with fiber or adding fiber to your child’s feedings. Also, ask your doctor or dietitian about adding fruit juice (apple or prune) or a small amount of light Karo™ syrup (one teaspoon if your child is less than one year of age) to the feeding.
- Always watch your child closely for any sign of trouble breathing during feedings and during tube placement:
- sudden and rapid breathing
- pulling in of the chest muscles
- bluish color around the lips
If any of these signs occur, stop the feeding, take out the NG tube, and call your child’s doctor.
Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.