During illness and recovery, your child may need a feeding tube to help to get the calories and nutrients they need.
Tube feeding, or enteral nutrition, provides nutrition in liquid or formula form. It helps children who do not get enough calories or nutrients by eating or drinking by mouth. Some medicines may also be given through the feeding tube.
Enteral nutrition may provide all or part of your child’s nutrition. Many children can still eat and drink by mouth with a feeding tube.
It is important to help your child understand that a feeding tube is not a punishment. Needing nutrition support is not their fault. Good nutrition is important for growth, energy, and healing. Your dietitian will work with you and your health care provider to plan tube feedings. A dietitian is a health professional with special training in diet and nutrition.
The dietitian will prescribe your child’s nutrition formula based on their needs for:
Calories
Hydration
Carbohydrates
Fats
Protein
Vitamins and minerals
Types of feeding tubes
Feeding tubes give liquid nutrition directly into the stomach or intestine. There are 2 main ways feeding tubes are placed:
Through the nose (non-surgical)
Through a small cut or incision in the abdomen (surgical)
The most common feeding tubes include nasogastric (NG) tubes (through the nose) and gastrostomy (G) tubes (through an incision). But there are several types of feeding tubes based on how and where they are placed in the digestive system.
Many patients can get nutrition from standard formulas (liquid mixtures of nutrients) made for tube feeding. Other children need special formulas for medical conditions such as allergies, diabetes, or digestive problems. For infants, breast milk is often preferred.
There are 3 main ways to give tube feedings:
Bolus feeding: Patients get large doses of formula several times a day. This timing is most like a normal eating routine.
Continuous feeding: An electronic pump gives small amounts of formula for long periods of time, up to 24 hours a day. Some children may need this type of feeding to help reduce nausea and vomiting.
Gravity feeding: Formula drips at a slow rate through a feeding bag on an IV pole. The amount of time to use gravity feeding varies by patient. Gravity feeding is a low-tech, manual option that works well at home.
You can prevent most side effects by following care and feeding instructions. Follow instructions for skin care around the tube site to prevent irritation or infection. Make sure your child does not touch or pull on the tube.
It is important to work closely with your nutrition professional. Nutrition needs may change based on health factors and side effects such as vomiting or diarrhea.
Tube feedings at home
Your child may go home with a feeding tube. The care team will make sure that you know how to:
Mix your child’s formula
Give feedings
Take care of the feeding tube
Supplies needed
Formula: Most formula comes ready to use. Some formula comes in a powder or liquid that you mix with water.
Syringe: Needleless syringe that connects to the feeding tube (ENFit syringe)
Feeding pump if using continuous or gravity feeding
Formula bag with tubing if using continuous or gravity feeding
IV pole if using continuous or gravity feeding
Feeding adapter tube if your child has a "button" G-tube
Tips for tube feeding at home
Keep these tips in mind for tube feeding at home:
Always wash hands with soap and water or use hand sanitizer before and after giving a feeding or caring for the feeding tube.
Position your child sitting up or at an incline for feedings so that their head is higher than their stomach.
Do not let the syringe or bag get completely empty during the feeding. If air gets in the feeding tube, it can cause stomach bloating or discomfort.
Watch for signs of nausea, vomiting, stomach swelling, or irritability. If these things happen, stop the feeding, and contact your health care provider.
Check the skin around the tube for signs of irritation or infection.
Wash the syringe (and adapter if used) with warm water and dishwashing soap after each use.
Prepare and store formula as instructed:
Refrigerate mixed formula, and discard after 24 hours.
Ready-to-feed formulas do not have to be refrigerated until they are opened. Once open, they are only good for 24 hours.
Throw out any ready-to-feed or prepared formula that has been opened and stored in the refrigerator for 24 hours or longer.
Keeping healthy mealtime routines
Try to make feedings comfortable and relaxed. Talk to your child and have fun. This will help your child adapt and feel better about feedings.
Here are tips for different age groups to help keep normal meal routines:
Babies: Hold your baby in your arms during feeding. Talk or sing to your child, make eye contact, and create a special bonding time.
Toddlers: Let your child sit in the chair they used before getting the feeding tube. Allow them to hold utensils or play with pretend food.
Older children: Have your child sit with the family at mealtimes. Involve your child with planning and preparing meals. Make it a special time to connect with one another.
Practicing mouth and face movements
Help your child continue to use their mouth and lips so they stay comfortable with eating by mouth. Using touch, play, and age-appropriate activities builds oral skills and awareness. This can help your child return to eating and drinking more easily later.
Babies: Give your baby a pacifier, toy, or vibrating teether. Touch your baby’s lips, mouth, and gums during feedings. You can also touch, stroke, or pat your baby while you sing or make funny sounds together.
Toddlers: Touch your toddler’s lips, mouth, or gums during feedings. Give your child mouth toys. Have them make funny sounds that use different mouth movements. Rub different textured materials on your child’s face during feedings.
Preschool and school-age children: Have your child blow bubbles or play musical instruments during feedings.
A speech-language pathologist can recommend oral stimulation tools or speech therapy activities to help your child with the skills needed for feeding and swallowing.
When to call your care team
Call your child’s care team if you notice:
Vomiting or diarrhea that does not stop
Weight loss or weight gain that seems unusual
Signs of dehydration (dry mouth, dry diapers, dark yellow urine)
Redness, swelling, or drainage around the tube site
Your child may get medicines through a feeding tube. Learn how to safely give your child medicines, including what supplies you will need and how to prepare the medicine.
A feeding tube is a medical device that connects to the stomach or small intestine to provide nutrition support for children and teens who cannot take food by mouth. Nutrition given by tube feeding is called enteral nutrition.
Parenteral nutrition (PN or TPN) is IV nutrition given as a liquid solution through a catheter placed in a vein. Find information on parenteral nutrition.
