How to Give Syringe Bolus Feedings Through a Feeding Tube

What is bolus feeding?

Bolus feeding is a way to give liquid or formula nutrition through a feeding tube (enteral nutrition). Bolus feedings usually give large doses of formula several times a day through a syringe attached to a feeding tube or G-tube button in the stomach.

Other ways to give tube feedings include continuous feeding (given slowly with a pump) and bolus feeding with a bag. Your care team will help you choose the best method for your child. 

Always follow the instructions given by your care team on how to give feedings. 

Supplies needed

Supplies for bolus feedings include:

• Amount of formula for 1 feeding at room temperature
• Water
• Syringe without a needle (a 60 mL ENFit syringe)
• Feeding adapter tube (only if your child has a G-tube button)

Wash your hands with soap and water or use an alcohol-based hand sanitizer before and after each of the following steps.

Prepare the formula

Your dietitian will choose the best formula for your child’s nutritional needs. They will tell you how much and how often to give the formula. You will need to know:

• Type of formula
• How many milliliters (mL) of formula to give each feeding
• How often to give the feeding (usually every 3–4 hours)

Most formulas come ready to use in a can or carton. After opening the container, you can pour the formula into a clean measuring cup or container.

Some formula comes as a powder or liquid that you mix with water. If mixing is needed, your care team will tell you how.

Formula that has been opened or mixed can be stored in the refrigerator for 24 hours. Throw away any unused formula after 24 hours.

The formula should be at room temperature when you give it to your child.

• If you keep formula in the refrigerator, take it out about 1 hour before feeding time and allow to warm to room temperature.
• To warm refrigerated formula, pour the formula for the feeding into a clean container, close the container, and place in a bowl of warm water. 
• Never use a microwave to heat formula because it will heat the formula unevenly and could harm your child. 

Attach the feeding adapter (if your child has a G-tube button)

1. Open the G-tube button plug.
2. Insert the tip of the adapter into the small hole in the middle of the G-tube button. Make sure the lines on the adapter line up with the lines on the button.
3. Gently push in the adapter as far as it can go. Twist to lock.
4. Clamp the adapter.

Position your child sitting up

Make sure your child is sitting up during feedings. Their head should be higher than their stomach. 

You can hold a small child on your lap or have them sit in a highchair. If your child is older, they can sit in a chair or highchair. If they are in bed, raise the head of the bed to an incline (30–45 degrees). You can put pillows behind your child’s head to help them sit up in bed.

Give the feeding

1. Insert the tip of the syringe into the container of water.
2. Pull back on the plunger to fill the syringe with the recommended amount of water for a flush.
3. Take the plug out of the feeding tube opening or adapter tube.
4. Attach the tip of the syringe to the feeding tube.
5. Hold the syringe upright (tip facing down) and slightly above your child’s stomach.
6. Unclamp the feeding tube or adapter.
7. Push the plunger in to flush the feeding tube.
8. Take the plunger out of the syringe.
9. Slowly pour the recommended amount of formula into the syringe. Let it drain into the tube by itself (by gravity). Do not push the formula into the tube.
10. When all of the formula has gone in, pour the recommended amount of water into the syringe to rinse the feeding tube.
11. Clamp the feeding tube after the water has gone through.
12. Disconnect the syringe.
13. Remove the adapter tube (if needed).
14. Put the plug back into the feeding tube opening.

Keep your child sitting up or at an incline for 1 hour after feeding. Talk to your care team if you have any questions about tube feedings. 

Watch your child for any signs of nausea, vomiting, stomach swelling, pain, or being cranky or fussy during the feeding and right after. If any of these things happen, stop the feeding, and call your care team.

Clean your supplies: Wash the syringe (and adapter if you used one) with warm water and dishwashing soap. Rinse them and let them air dry between feedings. You may use the syringe and adapter for up to 2 weeks. Replace them sooner if you cannot get them completely clean.

Tips for giving bolus feedings

• Flush the feeding tube before and after each feeding.
• If your child fusses or cries during a bolus feeding, stop the feeding until your child is calm. You can slow or stop the feeding by pinching the tube with your fingers or lowering the syringe. 
• You can make the formula go in faster or slower by raising or lowering the syringe. Holding the syringe higher makes the formula go in faster.
• Never use the syringe plunger to force the formula into the feeding tube. Do not let the syringe get completely empty during the feeding. Air can get into your child’s stomach through an empty syringe. This can cause discomfort.

Safety reminders for bolus feeding

• Follow your care team’s instructions carefully.
• Use a clean syringe.
• Make sure the formula is at room temperature before feeding.
• Do not use the syringe plunger to force the formula into the feeding tube.
• Make sure your child does not touch or pull on their feeding tube.
• Watch your child for signs of discomfort or bloating.

When to call your care team

Contact your care team if you notice any of the following around the feeding tube site:

• Signs of infection, such as fever, pus, bad smell, swelling, tenderness, or redness that worsens or spreads 
• Irritation, pain, or soreness that does not improve or interferes with your child’s daily activities
• Bleeding or leaking that occurs often, in large amounts, or does not stop
• Trouble securing the feeding tube

Questions to ask your care team

• What kind of formula should I use?
• How much formula should I give and how often?
• What kind of water should I use to flush the feeding tube?
• How much water should I use to flush the feeding tube?
• What should I do if the formula does not go into the tube easily?
• What problems should I watch for during or after feedings?
• How do I know if I am feeding too fast or too slow?
• When should I contact the care team?

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