Administering Tube Feedings for Your Child

Your child will be receiving tube feedings at home. There are some general guidelines to follow for care and cleaning of the feeding tube and supplies. You should ask your child’s nurse or doctor any questions you have about your child’s specific feeding tube and supplies.

Preparing Your Formula

  • Always start with washing your hands.
  • 
Store unopened cans of formula at room temperature.

  • Keep any open cans or containers of prepared formula in the refrigerator. Throw out unused formula by following the directions on the formula container.

Checking Placement of the Tube

Nasogastric Tube or Orogastric (NG/OG Tube)

  • For bolus or overnight feeds:

    • Check placement before hooking up each feeding.

    • Attach an oral syringe filled with 5ml of air to the end of the tube and push the air in.
    • Draw back fluid into the syringe.
    • 
Check the pH of the fluid.
  • For continuous feeds:

    • Check placement of the tube once a day as long as your child’s condition has not changed.
    • Stop the feed and flush the tube with the amount of water or air as you have been taught.
    • Turn the feeding off for 1 hour.

    • Flush the tube with 5ml of air and draw back fluid into the syringe.
    • 
Check the pH of the fluid.

NG/OG Reminders

  • Check the pH BEFORE giving your child any medications and before giving anything to eat or drink.
  • Always check that the mark on your child’s feeding tube has not changed. If the mark has
moved, reposition the tube and check your child’s pH.
  • Always check the placement (pH) of your child’s feeding tube if they do not seem the same and you think something is wrong.

  • If the pH is greater than 5 and your child is not having any trouble breathing or changes in behavior, wait 15-30 minutes and recheck the pH.
    • After rechecking, if the pH is still greater than 5, remove the tube and reinsert it. After reinserting the tube, if the pH is still greater than 5, call your doctor or nurse practitioner.

To Prevent the Tube from Clogging

  • Always flush the NG/OG tube with the amount of water or air as you have been taught before and after each feeding and before and after giving medications.

  • For continuous feeds, flush every 12 hours.
  • If your tube does become clogged, attach a 5ml oral syringe with warm water to the end of your feeding tube. Try to flush the tube. If you are unable to flush, pull back on the plunger of the syringe. Repeat this push and pull action up to 5 times. If you still cannot flush the tube, try using warm water in a 3ml or 1ml oral syringe and repeat the above steps.

Gastrostomy, Gastrostomy/Jejunostomy, Jejunostomy, ND or NJ Tubes (G, G/J, J, ND, or NJ Tubes)

For routine care of your child’s tube, follow the individual instructions for the type of tube your child has.

Positioning During Tube Feedings

  • Keep your child’s head elevated about 30-45 degrees.

  • Hold an infant on your lap or place him in an infant seat.

  • Speak to your healthcare team about the safest way to position your infant or child during overnight feedings.

Administration of Enteral Feedings Using a Feeding Pump

  • If your child will be receiving tube feedings at home using a pump, the pump will be set according to the feeding orders written by your child’s doctor.
  • 
The pump is run by electric or battery power and can be made portable by using a back pack.
  • Formula is added to the feeding bag and then run through the tubing to eliminate air before you connect to your child’s feeding tube. This is called priming. You can place the tubing into the pump and press the Prime button to clear the air from the tube.
  • Rate is how fast the formula will go through the pump and feeding tube and into your child’s stomach. This number is measured in milliliters per hour (ml/hr).

  • Dose is the total amount your child will be receiving for the feeding. It is measured in mls. The dose is calculated by multiplying the rate by amount of hours the feeding is ordered to run. Example: 25ml/hr to run for 8 hours. The dose would be 25 x 8 = 200ml.

  • The pump measures every ml as it passes through the pump and into your child. This amount is called volume. At the start of the feeding the volume is zero. At the end of the feeding the volume will be equal to the dose that was programmed.

When the feeding is done, disconnect the feeding set-up from the tube and flush the tube with the amount of water or air as you have been taught.

Administration of Enteral Feedings via Gravity

  • To administer the feedings you can use a syringe with extension tubing or a feeding bag.
    • If using a 60ml syringe:
      • Remove plunger.
      • Attach extension tubing.
      • Clamp the tubing.
      • Fill the syringe with formula or breastmilk.
      • 
Open the clamp and allow the liquid to flow through the tubing. This is called priming.

      • Clamp the extension tubing.

      • Connect the extension tubing to your child’s feeding tube.
Position the syringe above your child’s stomach.
      • 
Regulate the flow of liquid by adjusting the level of the syringe or adjusting the clamp on the tubing.
    • Holding the syringe higher will make the liquid go in faster. Holding the syringe lower will make the liquid go in slower.
    • Generally it should take 20-30 minutes for the volume to flow in. Note the syringe will only hold 60ml at one time. If your child’s feeding amount is greater than 60ml you may add more to the syringe as it begins to empty.
      • If using a gravity bag:
        • Close the clamp on the tubing.
        • 
Fill the bag with the amount you need for the feeding and close the lid on the bag.
        • Open the clamp and allow the liquid to flow through the tubing. This is called priming.

        • Close the clamp.
Attach the tubing to your child’s feeding tube.

        • Hang the bag above your child’s stomach.
        • 
Regulate the flow of liquid by adjusting the level of the bag and adjusting the clamp on the tubing.
      • Hanging the feeding bag higher will make the liquid go in faster. Holding the feeding bag lower will make the liquid go in slower.

When the feeding is done, disconnect the feeding set-up from the tube and flush the tube with the amount of water or air as you have been taught.


Cleaning Your Tube Feeding Supplies


Feeding bags and syringes must be cleaned as indicated. To clean the supplies:

  1. Empty any extra formula into the sink.
  2. Fill the bag or syringe with warm water, rinse, and pour out the water. If it is difficult to get 
the bag or syringe clean, rinse it through with water 2-3 times. 

  3. Once the bag or syringe is clean, fill it with warm water again and let the water run through 
the tubing until the tubing is clear.
  4. Hang all feeding bags to dry with the cover and roller clamps open. Syringes and tubing 
should be separated and left on a clean paper towel to dry.
  5. Follow your homecare company’s instructions for cleaning and changing the feeding bag or 
syringe. 


Cleaning the Feeding Pump

  1. If you are using a feeding pump, turn off the pump and disconnect the pump from the power source before cleaning.
  2. Wipe the outside surface of the pump with a damp cloth or sponge.
  3. Clean the drop sensors of the pump with damp cotton swabs or Q-tips. Follow 
manufacturer’s cleaning instructions.
  4. Do not put the pump in water or any type of cleaning solution. 


Ordering Supplies

  • It is best to reorder supplies one month at a time.
  • 
Plan ahead and reorder before you use your last bag or set of tubing.
  • Be sure to reorder supplies before weekends and holidays.

Call Your Doctor or Advanced Practice Nurse If Your Child

  • Has watery stools or diarrhea

  • Has constipation
  • 
Is vomiting repeatedly with feeds
  • 
Is experiencing bloating of his belly or pain

  • If you have any questions or concerns about your child’s feeds or feeding tube

07:B:21
Written 2/99
Revised 5/99, 7/99, 8/00, 6/02, 3/06, 7/11, 8/11/11, 5/13/14
(Arabic/Spanish)

©The Children’s Hospital of Philadelphia 2014. Not to be copied or distributed without permission. All rights reserved.

Patient family education materials provide educational information to help individuals and families. You should not rely on this information as professional medical advice or to replace any relationship with your physician or healthcare provider. 


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