Enteral Nutrition (Tube Feeding)

What is enteral nutrition?

Tube feeding, or enteral nutrition, provides nutrition in liquid or formula form through a hollow tube placed into the stomach or intestine. Some medicines may also be given through the feeding tube.

Dietitians are experts in food and nutrition. Your dietitian will work with you and your doctor to plan tube feedings to make sure your child’s nutrition needs are met. You will learn how to mix formula, give feedings, and take care of the feeding tube.

Read more about clinical nutrition and nutrition support. 

Types of feeding tubes

There are generally two ways feeding tubes are placed:

1. Through the nose (non-surgical)
2. Through a small cut or incision in the abdomen (surgical)

The most common feeding tubes include nasogastric tubes (NG tubes) and gastrostomy tubes (G tubes). However, there are several types of feeding tubes based on how and where they are placed in the digestive system.

Learn more about types of feeding tubes and how they are placed.

During illness and recovery, some patients may not be able to get all the calories and nutrients they need by mouth. This is no one’s fault. It is important to help children understand that nutrition support (enteral nutrition) is not a punishment. Most children adapt well to having a feeding tube. 

Make sure your child doesn’t touch or pull on the tube. Follow instructions for skin care around the tube site to prevent irritation or infection.

Side effects of tube feeding

The most common side effects of tube feeding are nausea, vomiting, stomach cramps, diarrhea, constipation, and bloating.

Other possible side effects may include:

• Infection or irritation where the tube is located
• Tube moving out of position or getting dislodged
• Formula getting into the lungs.

Most side effects can be prevented by following instructions for care and feeding.

Nutrition in children with feeding tubes

For many patients, a feeding tube is often used to supplement what the child is able to eat by mouth. Other patients may get all nutrients from a feeding tube.

A dietitian or nutritionist will make sure that your child’s specific nutrition needs are met. Your child’s nutrition formula will be prescribed based on:

• Calories
• Hydration
• Carbohydrates
• Fats
• Protein
• Vitamins and minerals

Many patients can be fed with standard formulas. For infants, breast milk is often preferred. Other children need special formulas for medical conditions such as allergies, diabetes, or digestive problems.

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.

Ways to give enteral feedings

There are 3 main ways to give tube feedings: bolus feeding, continuous feeding, and gravity feeding.

Bolus feeding – In bolus feeding, large doses of formula are given several times a day through the feeding tube. This is most like a normal eating routine.

Continuous feeding – In continuous feeding, an electronic pump is used to give small amounts of formula for long periods of time, up to 24 hours a day. Some children may need continuous feeds to help reduce nausea and vomiting.

Gravity feeding – In gravity feeding, a feeding bag is placed on an IV pole. A set amount of formula drips through the tube at a slow rate. The amount of time varies by patient. 

Enteral feeding at home

Your child may go home with a feeding tube. The care team will make sure that you know how to give feedings and care for the feeding tube. Watch for problems such as:

• Weight gain or loss
• Vomiting or diarrhea
• Dehydration
• Infection

Equipment and supplies that families may need include:

• Formula: Most formula comes ready to use. Some formula comes in a powder or liquid that you mix with water. 
• Syringe
• Feeding adapter tube if your child has a button
• Feeding pump if receiving continuous or gravity feeding
• Formula bag with tubing if receiving continuous or gravity feeding
• IV Pole if receiving continuous or gravity feeding

Tips for tube feeding at home:

• Always wash hands with soap and water before giving a feeding.
• Make sure your child’s head is positioned higher than the stomach.
• Throw out any ready-to-feed or prepared formula that has been opened and stored in the refrigerator for 24 hours or longer.
• 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.
• Do not let the syringe get completely empty during the feeding.
• Wash the syringe (and adapter if used) with warm water and dishwashing soap after each use.
• When giving nutrition, watch for signs of nausea, vomiting, stomach swelling, or irritability. If this happens, stop the feeding, and call your doctor right away.
• Check the skin around the placement site for signs of irritation or infection.

How to help your child adjust to tube feedings

Keep healthy mealtime routines

• Try to make feedings comfortable and relaxed. Talk to your child and have fun. This will help your child feel better about feedings.
• Keep up normal meal routines. Here are tips for different age groups:
  • 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. Take the emphasis off food during meals and make it a special time to connect with one another.

Help your child remember how to eat by mouth

Eating involves the mouth and face. It is important to help your child use their mouth and lips and stay aware of the movement and feeling of their mouth and face. Touching your child’s lips, mouth, or gums during feedings will make it easier for your child to go back to eating by mouth when the feeding tube comes out.

• 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. Practice making funny sounds. Rub different textured materials on your child’s face during feedings.
• Pre-school and school-age children: Blow bubbles or play musical instruments during feedings.

A speech language pathologist can give you other suggestions for helping your child remember that feeding involves the mouth and face. Your therapist may recommend oral stimulation tools or activities to help your child develop or maintain the skills needed for feeding.