Feeding tube in newborn babies

Tube feeding | Bliss

Your baby may be fed using tube feeding while on the neonatal unit. Find out why this might be and information about caring for your baby while they are being tube fed.

What is tube feeding?

During tube feeding, breast milk or formula is given through a tube passed into your baby’s nose or mouth to their stomach. Types of tube feeding include the following:

Nasogastric tube feeding (also called an NG tube) - This is when a baby is fed through a small soft tube, which is placed in the nose and runs down the back of the throat, through the food pipe (oesophagus) and into the stomach.
Orogastric tube feeding - This is when a baby is fed through a small soft tube, which is placed in the mouth and runs down the back of the throat, through the food pipe (oesophagus) and into the stomach.

Babies who are very premature or sick may need to be fed using parenteral nutrition (PN) at first.

Why does my baby need to be fed using tube feeding?

Tube feeding is often used to feed premature and sick babies as they can be too small and sick to breastfeed or bottle feed at first. Babies born premature or sick have a low supply of energy and nutrients, so it is important that they are able to have small nutritional feeds often, without lowering their energy levels.

In babies born premature, the coordination of sucking, swallowing and breathing needed for effective feeding is usually not fully established until about 32 to 34 weeks’ gestation (although this is different for different babies). Babies born at term and sick may also take longer to co-ordinate feeding. Tube feeding will help your baby receive enough nutrition to grow and develop.

Can I be involved in caring for my baby if they are being tube fed?

Yes, you can. Staff on the neonatal unit will encourage you to be as involved as possible in the care of your baby on the neonatal unit. If you feel comfortable doing so, they should show you and your partner how to give tube feeds. Staff on the neonatal unit will explain how tube feeding works and will teach you how to:

Check the tube is in the correct position before feeding
Prepare the milk and fill the syringe that is connected to the feeding tube
Position your baby correctly for tube feeds
Give the milk slowly to support comfortable digestion
Know what to look for during a feed.

This can feel quite scary at first, but with practice you should gain confidence. You will have the time to give the milk very slowly which helps your baby to digest more comfortably.

If your baby is well enough to come out of the incubator, you and your partner can also practice skin-to-skin contact with your baby while they are tube feeding. Skin-to-skin contact has lots of benefits for you and your baby, and helps parents to feel closer to their baby and more confident in caring for them.

When can my baby stop tube feeding?

In time, you may notice your baby demonstrating feeding cues during a tube feed. For example, they may open and close their mouth, put out their tongue or suck their fingers during a tube feed. This shows that they might be ready to practise breastfeeding or bottle feeding.

If you are planning to breastfeed and your baby is well enough to come out of the incubator, giving them lots of opportunities to be close to the breast may help them to learn to breastfeed. During a tube feed may be a good time to do this. When they are more mature and interested enough, some babies will start licking milk and in time practice sucking. As your baby starts to take more breast and bottle feeds, they will not need as many top-ups of milk from the feeding tube. This will depend on your baby’s energy levels and their ability to coordinate sucking, swallowing and breathing.

Some parents have concerns about their baby changing from tube feeding to breastfeeding, as it is more difficult to measure how much milk their baby is having. Your baby will show signs that they are receiving enough milk, such as feeding cues and wet and dirty nappies. The healthcare team supporting you will monitor your baby’s feeding and will manage any top-ups that might be needed. Talk to a member of staff on your unit if you have any concerns.

What will happen if my baby needs to go home from the neonatal unit with a feeding tube?

If your baby is going home with a feeding tube, a member of unit staff will show you how to feed and care for the tube yourself. It may be you or your community neonatal nurse who will replace the tube when you go home. This will depend on your baby’s needs, your preferences, and the support the unit provides.

Support will always be available if you do not feel comfortable with replacing the tube yourself. If you have any questions or concerns, talk to the unit staff.

Feeding Tube for Infants: Conditions, Procedure, and Risks

A feeding tube, also known as a gavage tube, is used to give nutrition to infants who cannot eat on their own. The feeding tube is normally used in a hospital, but it can be used at home to feed infants. The tube can also be used to give medication to an infant.

The feeding tube can be inserted and then removed for each feeding. Or it can be an indwelling feeding tube, which means it remains in the infant for multiple feedings. The feeding tube can be used to give both breast milk and formula.

A feeding tube is used for infants who do not have the strength or muscle coordination to breastfeed or drink from a bottle. There are other reasons why an infant might need a feeding tube, including:

lack of weight gain or irregular weight gain patterns
absence or weak sucking ability or swallowing reflex
abdominal or gastrointestinal defects
respiratory distress
problems with electrolyte imbalances or elimination

The insertion procedure involves the following steps:

Your nurse will measure the length from your baby’s nose or mouth to their stomach. They will then mark the tube so it’s just the right length for your infant.
They will lubricate the tip with sterile water or water-based lubricating gel.
Next, they will insert the tube very carefully into your infant’s mouth or nose. Occasionally doctors will insert the tube, but generally, a bedside nurse performs the procedure.

After it is placed, your nurse will check the tube for correct placement by inserting a small amount of air into the tube and listening for the contents to enter the stomach.

This indicates the tube has been placed correctly. The most accurate way to test that the tube is in the correct place without getting an X-ray is to withdraw some of the liquid from your baby’s stomach and test the pH with a simple testing strip. This will ensure that the tube passes into the stomach and not the lungs.

When the tube is inserted, it is taped to the nose or mouth so it stays in place. If your infant has sensitive skin or a skin condition, your doctor may use a pectin barrier or paste to make sure the skin doesn’t tear when the tape is removed.

There are also devices that secure the tube internally by using cloth tape that passes behind the nasal bone. To confirm proper placement, your doctor may order an X-ray of your child’s abdomen to ensure that the tube is in the stomach.

After the tube is firmly in place, the infant is given formula, breast milk, or medicine by injection with a syringe or through an infusion pump. You can hold your baby while the liquid moves slowly through the feeding tube.

After the feeding is complete, your doctor will either cap off the tube or remove it. You should make sure your infant remains upright or inclined to prevent the feeding from being regurgitated.

There are very few risks associated with feeding tube use. But, it can be uncomfortable for the infant, no matter how gently it is inserted. If your child begins to cry or show signs of discomfort, try using a pacifier with sucrose (sugar) to provide relief.

Other side effects include:

slight nasal bleeding
nasal congestion
nasal infection

If you’re feeding your baby through a feeding tube at home, it’s important to watch for signs of tube misplacement.

Feeding through an incorrectly placed tube can lead to breathing difficulties, pneumonia, and cardiac or respiratory arrest.

Sometimes the tube is inserted incorrectly or accidentally becomes dislodged. The following signs might mean there is something wrong with the tube placement:

slower heart rate
slow or troubled breathing
vomiting
coughing
blue tinge around the mouth

Please seek emergency medical attention if your baby has any trouble breathing or has a blue tinge around the mouth.

It can be difficult to cope with feeding your infant through a feeding tube. It’s normal to feel a sense of anxiety about not breastfeeding or bottle-feeding your infant. Many babies only need to use feeding tubes until they become strong enough or well enough to feed on their own.

Talk with your doctor about the emotions you’re feeling. If you’re feeling sad, your doctor can help you find support groups and can even evaluate you for signs of postpartum depression.

Continuous milk feeding by nasogastric tube versus intermittent bolus milk feeding of preterm infants weighing less than 1500 g

Review question

Is continuous tube feeding through the nose or mouth better than tube feeding every two to three hours in very low birth weight preterm infants?

Relevance

Premature babies born weighing less than 1500 grams are unable to coordinate sucking, swallowing and breathing. Feeding through the gastrointestinal tract (enteral nutrition) promotes the development of the digestive system and the growth of the child. Therefore, in addition to feeding through an intravenous catheter (parenteral nutrition), premature babies can be fed milk through a tube inserted through the nose into the stomach (nasogastric feeding) or through the mouth into the stomach (orogastric feeding). Typically, a predetermined amount of milk is given over 10-20 minutes every two to three hours (intermittent bolus feeding). Some doctors prefer to feed premature babies continuously. Each feeding method has potentially beneficial effects, but can also have harmful effects.

Study profile

We included nine studies with 919 infants. Another study is pending classification. Seven of the nine included studies reported data on infants with a maximum weight of 1000 to 1400 grams. Two of the nine studies included infants weighing up to 1500 grams. The search is current as of July 17, 2020.

Main results

Infants receiving continuous feeding may achieve complete enteral nutrition slightly later than infants receiving intermittent feeding. Total enteral nutrition is defined as the intake of a given volume of breast milk or formula by the infant in the required manner. This promotes the development of the gastrointestinal tract, reduces the risk of infection from intravenous catheters used to provide parenteral nutrition, and may shorten hospital stays.

It is not known whether there is a difference between continuous and intermittent feeding in terms of the number of days needed to regain birth weight, days of feeding interruption, and rate of weight gain.

Continuous feeding may result in little or no difference in rate of increase in body length or head circumference compared to intermittent feeding.

It is not known whether continuous feeding affects the risk of developing necrotizing enterocolitis (a common and serious bowel disease in preterm infants) compared with intermittent feeding.

Certainty of evidence

The certainty of evidence is low to very low due to the small number of children in the studies and because the studies were designed in such a way that there could be errors in the results.

Translation notes:

Translation: Alexander Mazulov. Editing: Yudina Ekaterina Viktorovna. Project coordination for translation into Russian: Cochrane Russia - Cochrane Russia on the basis of the Russian Medical Academy of Continuing Professional Education (RMANPE). For questions related to this translation, please contact us at: [email protected]

Enteral nutrition (tube feeding)

What is enteral nutrition?

Sometimes during treatment and recovery, children with cancer cannot get the calories and nutrients they need orally. Tube feeding, or enteral nutrition, provides nutrition in the form of a liquid or mixture given through a tube that is inserted into the stomach or intestines. Some medications may also be delivered through such a tube (probe).

Typically, the tube is inserted in two ways:

Through the nose (non-surgical method)
Through a small incision in the abdomen (surgical method)

Most commonly used are nasogastric tubes and gastrostomy tubes. But there are several types of enteral feeding tubes that differ in the method of insertion and location in the digestive tract.

Sometimes the patient is simply not able to eat enough calories or protein. There is no fault in this. It is important to help your child understand that nutritional support is not a punishment. Most children get used to the enteral feeding tube quickly. It is important that the child does not touch or pull the phone. Follow skin care instructions at the insertion site to avoid irritation or infection.

A nasogastric tube is inserted into the stomach or small intestine through the nose and throat.

Types of enteral feeding tubes

An enteral feeding tube connects to the stomach or small intestine. The location depends on how the patient tolerates the formula and how well their body is able to digest the nutrients. If possible, they try to place the probe in the stomach so that digestion occurs naturally.

There are 5 types of enteral feeding tubes:

Nasogastric Tube . A nasogastric tube is inserted into the stomach through the nose. It passes through the throat, esophagus and into the stomach.

Nasojejunal Probe . A nasojejunal tube is similar to a nasogastric tube but passes through the entire stomach into the small intestine.

Gastrostomy Tube (Gastrostomy Probe) . A gastrostomy tube is inserted through a small incision in the skin. The probe in this case passes through the wall of the abdominal cavity directly into the stomach.

Gastrojejunostomy tube (gastrojejunostomy probe) . The gastrojejunostomy tube is inserted into the stomach like a gastrostomy tube, but passes through the stomach into the small intestine.

Jejunostomy Probe . A jejunostomy tube is inserted through a small incision in the skin and passed through the abdominal wall into the small intestine.

Nasal tubes, including nasogastric and nasojejunal tubes, are generally used for short-term enteral feeding, usually not more than 6 weeks. The probe comes out of the nostril and is attached to the skin with adhesive tape. Nasogastric and nasojejunal tubes have a number of advantages, such as a low risk of infection and a simple insertion procedure. However, the probe must be attached to the face, and this worries some children. Other children may have problems with the nasogastric tube due to chemotherapy, which irritates the skin and mucous membranes.

Surgical insertion tubes - gastrostomy tube, gastrojejunostomy tube and jejunostomy tube - are used for longer periods of time or when a nasal tube cannot be placed in the child. The opening in the abdominal wall through which the probe is inserted is called the stoma. A long tube or a "button" (low profile) probe may be visible on the patient's body. After healing, the stoma is usually pain free and the child can perform most daily activities.

Insertion of nasogastric and nasojejunal tubes
Gastrostomy, Gastrojejunostomy and Jejunostomy Insertion

After healing, the stoma usually does not hurt. The child can perform most daily activities.

Side effects of enteral nutrition

The most common side effects of enteral nutrition are nausea, vomiting, stomach cramps, diarrhoea, constipation and bloating.

There may be other side effects:

Infection and irritation at the insertion site
Probe misaligned or falling out
Lung feeding formula

Most side effects can be avoided by following the care and nutrition instructions.

Baby feeding with tubes

It is the responsibility of the nutritionist to provide the baby with all the necessary nutrients. In children with cancer, an enteral feeding tube is often used in addition to what the child can eat normally. However, some patients have to enter all the nutrients through a tube.

The patient is prescribed a mixture containing:

Calories
Fluid
Carbohydrates
Fats
Protein
Vitamins and minerals

Standard formulas are suitable for many patients. For babies, it is preferable to use breast milk. Some children need special formulas that take into account their characteristics: the presence of allergies, diabetes or digestive problems.

It is very important for family members to work closely with a nutritionist. Nutritional needs may change due to changes in the child's health or side effects such as vomiting or diarrhea.

Types of enteral feeding

There are three types of enteral feeding - bolus, continuous and gravity.

Bolus feeding - large doses of mixture are given to the patient by tube several times a day. This species is closest to the usual diet.

Continuous feed - electronic pump delivers small doses of formula for several hours. Some children may need continuous feeding to reduce nausea and vomiting.

Gravity Feeding - A bag of formula is placed on the IV stand and a predetermined amount of formula is dripped through the tube at a slow rate. The duration of such nutrition depends on the needs of the patient.

Enteral feeding at home

Children can go home with a feeding tube. The doctors will ensure that family members know how to feed and care for the probe. Family members need to pay attention to the following issues:

Weight gain or loss
Vomiting or diarrhea
Dehydration
Infection

Formulas, Consumables, and Equipment Required:

Formula: Most enteral formulas are sold ready-made. Some are available as a powder or liquid to mix with water.
Syringe
Adapter tube (if the child has a button tube for long-term enteral nutrition)
Pump (with continuous power)
Feeding formula bag with tubing (for continuous feeding)
IV Stand (Gravity Feed)