What is tube feeding for 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.

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.

Enteral feeding tube types

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 if 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 ingestion of formula

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

Feeding babies with tubes in place

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 the 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 fed)

General tips for enteral feeding at home:

Always wash your hands with soap and water before feeding your baby.
Make sure the baby's head is above the stomach.
Throw away any ready-made or homemade formulas that have been opened and kept in the refrigerator for 24 hours or more.
Store mixed formulations in the refrigerator and discard after 24 hours.
Ready-to-use formulas do not need to be refrigerated.
Do not empty the syringe completely during feeding.
Wash the syringe (and transfer tube, if used) with warm water and dishwashing detergent after each use.
Watch for signs of nausea, vomiting, bloating or irritability while feeding. If you notice these signs, stop feeding and contact your doctor immediately.
Check the skin around the injection site for signs of irritation or infection.

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Modified November 2018

Bolus Feeding Using a Syringe)

Your child is discharged from the hospital with a nasogastric (NG) feeding tube in place. The tube is a thin, soft tube that is inserted into the baby's stomach through the nose. This tube delivers liquid food directly to the stomach. Before your baby was released from the hospital, you were shown how to feed with a nasogastric tube. This memo will help you remember the necessary procedure for feeding at home. You can also get help from a district nurse at your home.

NOTE: There are many different types of nasogastric tubes, feeding syringes, and pumps. The appearance and function of the nasogastric tube and accessories prescribed for your child may differ from those shown and described below. Always follow the advice of your child's primary care physician or district nurse. Write down their phone numbers in case you need help. Also write down the phone number of the facility that supplies medical equipment for your child. In the future, you will need to order additional accessories that your child may need. Write down all the phone numbers you need in the spaces below.

Healthcare provider phone number: _________________________________________________________

Home health nurse phone number: _________________________________________________

Medical supply company phone number: ______________________

Types of feeding

Two types of feeding can be performed with a nasogastric tube:
- bolus feeding. Several times a day, an amount of liquid food, commensurate with one meal, is fed through the tube. Bolus feeding is done with a syringe or pump;
- continuous feeding. Liquid food drips slowly through the probe. Continuous power is supplied by a pump.
Your child may be prescribed one or both types of food. Detailed instructions for each type of food are given below.

Syringe Bolus

Your child's doctor or district nurse will tell you how much liquid food to use with each bolus. You will also be told how many times a day to feed your baby. Record this information below.

How much to give at each feeding: _____________

Number of feedings per day (How often to feed): __________________________

Accessories

Actions

Wash your hands with soap and water.
Make sure the tube is in the stomach (as you were shown in the hospital). Be sure to perform this step BEFORE feeding .
Check liquid food label and expiration date. Never use jars (or bags) with food that have already expired. In this case, you must use a new jar (or bag) with food.
Open the hole plug at the end of the food probe.
Remove the plunger of the feeding syringe.
Connect the feeding syringe to the feeding port of the probe.
Gently bend or squeeze the probe with one hand. While holding the tube bent or pinched, slowly draw the liquid food into the feeding syringe with your free hand. In this case, the food will not flow through the probe, which will allow you to measure its amount.
Fill the feeding syringe to the level prescribed by the child's healthcare provider.
The probe can now be released.
Hold the feeding syringe straight. In this case, the food will pass through the probe by gravity without additional pressure. Adjust the angle of the feeding syringe to control the rate of fluid flow.
If the food flows too slowly or does not flow at all, insert the plunger into the syringe. Gently, lightly push the piston. This will remove any particles blocking or clogging the probe. Do not push the syringe plunger all the way or with force.
Refill the feeding syringe with food if necessary. Repeat the above steps until the child receives the prescribed amount of food.
After feeding, rinse the tube with water (as you were shown in the hospital).
Disconnect the feeding syringe.
Close the cap on the food inlet of the probe.

AddiAdditional instructions:_________________________________________________________________________________

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Call your doctor right away if you experience any of the following.

The child has trouble breathing.
Formation of redness, swelling (swelling), leakage (leakage), ulcers (sores) or suppuration (pus) on the skin in the area of the probe.
Presence of blood (blood) around the probe, in the child's stool or stomach contents.
Baby coughing (cough), shortness of breath (choke) or vomiting (vomit) while feeding.
Urebenka swollen (bloated abdomen) or hard abdomen (rigid abdomen) (abdomen hard with light pressure).
Child diarrhea (diarrhea) or constipation (constipation).
Child temperature (fever) 38˚C ( 100.4° F) or higher.