HealthInfo Waitaha Canterbury

Tube feeding with a gastrostomy tube for babies and children

This factsheet tells you how to care for your child's feeding tube and stoma (the artificial opening into their stomach). It also tells you how to give feed and medications via the feeding tube.

Gastrostomy and feeding tubes

A gastrostomy is an artificial opening through your child's abdomen into their stomach. A feeding tube is inserted through the opening. This is so special liquid food (feed), medications and fluids can go directly into their stomach or small intestine (specifically the jejunum).

There are 2 types of gastrostomy tubes used in tamariki (children). PEG (percutaneous endoscopic gastrostomy) is one. PEG-J (percutaneous endoscopic gastrojejunostomy) is the other. These terms describe how the tube is fitted and where it is placed.

The MIC-KEY button is a low-profile PEG or PEG-J device. It is used with an extension set that is needed to access the feeding port.

A – Feeding port. B – Flange (bumper). C – Clamp. D – MIC-KEY button. E – Extension set.

The PEG and PEG-J tubes have a flange (bumper) inside the stomach to keep the tube in the right position. The MIC-KEY button has a small balloon filled with water to hold it in place within the stomach.

Caring for your child's feeding tube and stoma

The stoma

• For the first 1 to 2 days after your child's tube is inserted, you can expect a small amount of discharge from the stoma. This will lessen as it heals.
• For the first 10 to 14 days, clean the stoma at least once a day using a saline solution.
• After 14 days, you can clean the stoma daily with warm soapy water.
• Always dry under the tube flange to minimise moisture against the skin.
• For the first 10 to 14 days, you can apply an antimicrobial dressing to your stoma. A dressing is not needed long term.
• After your child's tube is inserted, they can have a bath after 48 hours and swim after 2 weeks.

Your child's feeding tube

• Starting the day after your child's feeding tube's insertion, turn the tube 360 degrees daily. This stops the tube from sticking.
• Attach your child's feeding tube to their stomach using the tube fastener supplied by the Children's Outreach Nursing Service. This will stop it moving in the stoma.
• If your tamaiti gains or loses weight, you can reposition the flange (bumper) on the tube by sliding it up or down the feeding tube. It should always sit 1 to 2 mm away from the skin.
• Before starting the feed, always check that the flange (bumper) is in the same position.
• If you are not using the feeding tube for feeding, flush it with warm water at least twice a day.
• Contact the Children's Outreach Nursing Service if the feeding port on the tube needs replacing.

Feeding

Flush the feeding tube with warm water before and after you tube feed. Also flush it before and after you put medications down their tube.

If you have safe drinking water, you can use tap water to flush the tube. Otherwise, use boiled, cooled water.

If your tamaiti (child) has a jejunal tube, always use boiled, cooled water to flush their tube.

Feeding methods

There are 3 methods of tube feeding. These are gravity feeding, bolus feeding and pump feeding. Your dietitian will decide which type of feeding is best for your tamaiti.

• Gravity feeding – This is where the feed flows out of a syringe or feed bottle and into the feeding tube by gravity.
• Bolus feeding via a syringe – This is when your tamaiti has a set amount of feed at specified times during the day. This is like having meals at mealtimes.
• Pump feeding – This is when a pump is used to continuously deliver a set amount of feed through the feeding tube over a set amount of time.

Your dietitian will discuss these options with you in more detail and provide you with a plan and instructions when needed. See:

• Bolus or gravity feeding plan.
• Pump feeding plan.

Caring for your child's equipment and feed

• After feeding, wash the syringe with mild dishwashing detergent. Rinse it thoroughly and leave it to air dry.
• Place the syringe in a clean zip lock bag or a clean container with a lid. Store it in the fridge to prevent it being contaminated by bacteria.
• You can use each syringe for about 2 weeks.
• Giving sets (only used for pump feeding) can only be used for 24 hours. Discard them after you have used them for 24 hours and do not reuse them.
• Cover open cans or bottles of feed and store them in the fridge. Throw away any open, unused feed after 24 hours.
• You can use open ready-to-hang bottles of feed for 24 hours. Throw away any open unused feed after 24 hours.
• The feed should be at room temperature when you use it. If it has been in the fridge, leave it for 30 minutes before using it.

Medications

The hospital pharmacist will review your child's medications before you go home. They will make sure your tamaiti can take the medications through their feeding tube. There are some important points to note.

• Use the main port of the feeding tube for medications.
• Use the bolus feeding method (see above) to put medications down the feeding tube unless your dietitian or nurse advises otherwise.
• Flush the tube with 5 to 10 mL warm water before and after giving medications. This helps to prevent the feeding tube from blocking.
• If your tamaiti has more than 1 medication, give them each one separately. Flush the feeding tube with 5 to 10 mL of warm water between each medication.
• Finely crush each solid medication separately (a mortar and pestle is best for this). Mix it with 5 to 10 mL of water before putting it down the feeding tube.
• You can put liquid medications down the feeding tube without diluting them.

Troubleshooting

Problem	Possible cause	Recommended action
The skin around the tube is very red and painful and there is pus.	Your tamaiti may have an infection. First check that the flange is not too firm on their skin.	See your general practice team who may prescribe antibiotics. If your tamaiti has a fever, chills and tiredness, see your general practice team as soon as you can. If it is after hours, go to an after-hours clinic or emergency department.
The skin is "raw" around the tube insertion site. You may also notice increased fluid or discomfort around the area.	Your tamaiti may have what is called overgranulation tissue.	This is common and easily treated. Contact the Children’s Outreach Nursing Service within normal working hours. See the contact details below.
The feeding tube is blocked.	Try to unblock it using a 60 mL syringe half filled with warm water. Use a gentle push pull method to dislodge the blockage.	If you cannot clear the blockage, contact the Children’s Outreach Nursing Service. If your tamaiti needs the tube to stay hydrated and to take essential medications, contact Children’s Emergency Care if the blockage occurs after hours. See the contact details below.
Feed is leaking during feeding.	The tube may have come out of the stomach but still be sitting under their skin.	Contact the Children’s Outreach Nursing service. If after hours, contact Children’s Emergency Care.

Supplies, syringes and giving sets

Your dietitian and the Children’s Outreach Nursing Service will organise your first supply of syringes and giving sets. For an ongoing supply, contact Nurse Maude Supply Services (see below).

Give as much notice as possible. Let them know if you cannot collect the giving sets as they can courier them to you. There is no charge for giving sets or syringes but there is a small fee for delivery.

If you live in Ashburton, phone the Ashburton Supply Department (see below). You will need to collect the giving sets from the Supply Department.

If your pēpi (baby) or tamaiti needs a prescribed feed, your paediatric dietitian will prescribe the feed and organise for it to be delivered to your home. If you need to contact your feed supplier because your feed has not arrived, use the contact details below.

Email your dietitian at paediatric.dietitians@cdhb.health.nz for a new prescription when you have 10 days' supply of feed left.

Contact details

Children's Outreach Nursing Service

Phone: (03) 364-0033

Hours: Monday to Friday, 8.00 am to 4.30 pm

For urgent help after hours (for example, if the tube falls out), phone Christchurch Hospital on (03) 364-0640 and ask to speak with Children’s Emergency Care.

Nurse Maude Supply Services

Phone: (03) 375-4297

Email: supply@nursemaude.org.nz

Address: 21 Hawdon St, Sydenham

Hours: Monday to Friday, 8.30 am to 4.30 pm

Ashburton Hospital Supply Department

Phone: (03) 307-8462

Address: Ashburton Hospital, Entrance D, 12 Elizabeth St, Ashburton

Open for collection: Monday to Friday, 10.30 am to 2.30 pm

Feeding pump suppliers

For any issues with your pump, use the following contact details:

• FreeGo pump (Abbott). Phone 0800-738-090
• Flocare Infinity pump (Nutricia). Phone 0800-222-430

Feed suppliers

• Abbott and Nestle feed (via Health Works Pharmacy). Phone (03) 351-8633
• Nutricia feed. Phone 0800-688-747

  HealthInfo recommends the following pages

• Te Whatu Ora Waitaha – Caring for your child's gastrostomy

  More information about looking after your child's gastrostomy and what to do in case of problems.

Written by Nutrition & Dietetics, Te Whatu Ora Waitaha. Adapted by HealthInfo clinical advisers. Last reviewed September 2024.

Sources

Page reference: 1145150

Review key: HITUB-482880