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Tube feeding with a nasogastric or nasojejunal tube for babies and children

A nasogastric (NG) or nasojejunal (NJ) tube is a tube that goes through your child's nose and into their stomach (NG) or jejunum (NJ) (part of the small intestine). The tube allows your tamaiti (child) to take special liquid food (feed), medications and fluids if they cannot meet all their nutritional needs by eating normally.

Feeding

Important

Only put the following down the feeding tube:

the feed prescribed by your child's dietitian or doctor
water
prescribed medications (see below for how to put medications down the feeding tube).

Do not put puréed food down the feeding tube.

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. To stop the tube from blocking, also flush it every 3 to 4 hours during the daytime whether or not your tamaiti is feeding.

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

If your tamaiti has a NJ tube, always use boiled, cooled water to flush their tube.

Feeding methods

If your tamaiti has an NG tube, 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.

If your tamaiti has an NJ tube, you can only use pump feeding.

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:

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 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.

Caring for your 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 ready-to-hang bottles of feed for 24 hours. Throw away any 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.

Feeding tube blockage

The feeding tube may block if you do not flush it regularly or you do not give your tamaiti their medications correctly.

You can stop the tube from blocking by flushing the tube with warm water. You need to do this before and after each feed and before and after giving medications. You also need to do it every 3 to 4 hours during the daytime whether or not your child is feeding.

If the tube blocks, try the following to try to clear the blockage:

check for any kinks in the tubing
massage the tube from the nose end, out towards the end of the tube
insert a 60 mL syringe into the end of the tube
pull back the plunger and withdraw as much fluid as possible from the tube
take the syringe out of the tube and throw away the fluid you withdrew
half-fill a 60 mL syringe with warm water and attach it to the end of the tube, move the plunger back and forth to try to dislodge the blockage
massage the tube again and then use the back and forth action with the plunger to try to clear the tube
if you have repeated this 3 or 4 times and you cannot unblock the tube, contact the Children’s Outreach Nursing Service within normal working hours. Contact Children’s Emergency Care after hours (see contact details below).

Important

If the feeding tube comes out, contact Children’s Outreach Nursing Service within normal working hours. Contact Children’s Emergency Care after hours (see contact details below).

Supplies, syringes and giving sets

When your tamaiti is discharged from hospital, the ward will give you a small supply of nose plasters, 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 syringes and 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 child 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 your tube falls out), phone Christchurch Hospital on (03) 364-0640 and ask to speak with Children’s Emergency Care.