When Your Child Needs a Nasogastric (NG) Tube

If your child is having trouble swallowing food or liquids safely, the health care provider may advise tube feeding. Tube feeding is often done with a nasogastric (NG) tube. This is a soft, thin tube put through your child’s nose and down into the stomach. It sends liquid food directly to the stomach. Liquid food given through the NG tube is digested the same as food eaten normally. The NG tube may look uncomfortable. But it shouldn't be uncomfortable for your child.

Note

Take care to keep the tube from becoming a strangulation risk to your child. Follow your health care team's advice on how to secure the tube safely.

Why an NG tube is used

An NG tube is often used for many reasons. For instance, it may be used if your child:

• Needs short-term help getting nutrients or medicine.

• Isn't growing properly on regular food.

• Has trouble swallowing.

• Has an infection or is recovering from surgery and can’t eat food for a short time.

• Needs extra nutrition along with regular feeding.

• Has a serious illness (such as burns) that increases nutritional requirements.

An NG tube is only meant to be used for a short time. Your health care provider will talk with you about options if a long-term tube is needed.

Your child's NG tube may need to be replaced regularly. Ask your child's health care provider how often the NG tube needs to be replaced.

Replace NG tube: ______________________________

Contact information to keep handy

Ask for phone numbers to call if you need help. Also make sure you have the phone number for your child’s medical supply company. You will need to order more supplies for your child in the future. Write all of these phone numbers below.

Health care provider phone number: ____________________________________

Home health nurse phone number: _____________________________________

Medical supply company phone number: __________________________________

Caring for the NG tube

The tube will be first inserted in the hospital. You may find that it's easier to care for than you think. You’ll be shown how to correctly insert, remove, and care for the NG tube at home. You will learn how to check to make sure the tube is in the right place before feedings, fluids, or medicines are given. You will be taught how to use pH paper to check placement.

Feeding your child

You will need to feed your child through the tube. You will be shown how to do this before your child is discharged from the hospital.

• Your child should sit upright or with the head of the bed elevated during feeding and for 1 to 2 hours afterward. This position reduces the risk that they will inhale the food. And it allows gravity to help move the food through the digestive tract.

• If the formula is in the refrigerator, take it out ahead of time. Let it sit at room temperature for 30 minutes before feeding. Never warm formula in the microwave.

If you need more help, talk with the hospital about how to arrange a home health nurse to help you.

Checking tube placement

Every time you feed your child, you will need to make sure the NG tube is in the correct place. The end of the tube must be in your child’s stomach, not in the lungs or throat.

Look at your child after the tube has been placed and they have calmed down. If they are gagging, coughing, or turning blue, the tube may not be in the right spot. Remove it.

Gastric pH measurement. To check if the tube is in place, you will draw some liquid from the stomach and test the pH of the liquid. Do this check before each feeding: Check the pH of the liquid from the stomach using pH paper. Stomach (gastric) pH should be 1 to 5 if your child is not taking a proton pump inhibitor or H2 receptor antagonist. There are other things that can increase pH. Follow your provider's specific instructions.

Measuring NG tube insertion distance. Hold one end of the tube at the tip of your child's nose. Extend the tube to the earlobe and then to the middle of the belly. (It should be halfway between the bottom of the breastbone and the belly button.) Mark the tube at that point with a marker or piece of tape. This will let you know how far to insert the tube to reach the stomach. After you insert the tube, make sure the mark on the tube is at your child’s nose. If it’s not, the tube should be re-inserted to the correct position.

Types of feeding

There are two types of feeding with an NG tube. Your child may have one or both types of feeding. They are:

• Continuous feeding. Liquid food is dripped slowly through the tube for part or all of a day. This type of feeding is only done using a pump. The amount of food to be given and the time frame are often set on the pump for you. Don't change pump settings unless you’re told to do so.

  You will need to stop the feeding for a short time each day to check tube placement with pH strips. Follow your provider's instructions on how to do this:

  ______________________________________________________________________

• Bolus feeding. This is a meal-sized amount of liquid food given through the tube a few times a day. Bolus feeding is given using a syringe or a pump. Your child’s health care provider or home health nurse will tell you how much liquid food to use for each feeding. You will also be told how often to feed your child.

For bolus feeding, fill in the numbers below:

Feed your child on this schedule: ____________________________________________

Give this much at each feeding: ______________________________________________

Complications of tube feeding

• Having the tube in the nose or mouth can cause discomfort, pain, and sometimes bleeding. The tube can block sinuses. This can increase your child's risk for sinusitis.

• Incorrect placement of the tube into the airways causes coughing and gagging. It may also lead to pneumonia.

• Sometimes the tube can be blocked. If this happens, your child may not get enough nutrition.

• Some children may have nausea, vomiting, or diarrhea, especially when given bolus feeds.

When to call the doctor

Contact your child's health care provider right away if:

• You’re not able to place the tube.

• The skin around the tube site has redness, swelling, leaking fluid, or sores.

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

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

• Your child’s belly looks bloated or feels hard when gently pressed.

• Your child has diarrhea or constipation.

• Your child has a fever of  100.4°F ( 38°C) or higher, or as directed by the health care provider.

Call 911

Call 911 if:

• Your child has trouble breathing.