Nasogastric Feeding Tube Insertion in Children

A nasogastric feeding tube is a soft, flexible tube through which medicine, water, and liquid food can be given. It may be put in place when your child cannot eat, drink, or take medicines by mouth (orally), or when your child is not eating enough calories to meet his or her needs.

The tube is passed through the nose, into the back of the throat, and down into the stomach. This procedure is done while your child is awake. The insertion of the tube may be unpleasant for your child, but most children tolerate having a nasogastric tube fairly well.

The tube will easily be removed when it is no longer needed. If your child will need the tube at home, you and your child will be shown how to use it and check it, and what to do if it comes out.

Tell a health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems your child or family members have had with anesthetics or numbing medicines.
• Any blood disorders your child has.
• Any history of bleeding from the nose, throat, or stomach.
• Any recent injuries to your child’s face.
• Any surgeries your child has had, including surgery to the nose or sinuses.
• Any history of a deviated septum or other problems with the nose.
• Any other medical conditions your child has.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection at the tube placement site.
• Lung infection from fluid going into the lung (aspiration pneumonia).
• Bleeding.
• Allergic reactions to medicines.
• Damage to structures or organs, such as making a hole (perforation) in the tube that moves food from the mouth to the stomach (esophagus).
• Failure to successfully place the tube.
• Nosebleed.
• Incorrect placement of the tube in one of the main breathing tubes of the lungs (bronchi). This is rare.

What happens before the procedure?

• Your child’s healthcare provider will talk with you about the best way to hold and comfort your child during the procedure.
• Depending on your child’s age, your child may meet with a child life specialist. This specialist will explain the procedure and the feeding tube in a way that your child can understand.
• Follow instructions from your child’s health care provider about eating and drinking before the procedure.

What happens during the procedure?

• The inside of your child’s nose may be examined.
• Your child may be given a medicine to help him or her relax (sedative).
• A numbing solution or spray (topical anesthetic) may be put into the nose. Your child may be asked to inhale and swallow the anesthetic. A topical anesthetic may also be sprayed into the back of the mouth.
• Your child will be positioned in an upright, sitting position. If your child is young, you may hold him or her in your arms or on your lap.
• As soon as the nose and throat are numb, your child’s health care provider will put a slippery substance (lubricant) on the tip of the tube and place it in your child’s nose.
• The tube will be gently moved into the back of your child’s throat.
• Older children may be given a glass of water with a straw. As the tube is moved down your child’s throat, your child may be asked to take sips of water and try to swallow.
• When the tube reaches the stomach, your child’s health care provider may test the tube position by:
  • Using a syringe to remove stomach fluids through the tube for testing.
  • Taking an X-ray of your child’s stomach.
• When the tube is in the right place, it will be secured to your child’s nose with a bandage or a nasal bridle device. This will keep the tube from moving.
• The tube may be connected to a suction device or a pump to deliver medicine or liquids.
• A device may be placed on your child’s stomach to track the movement of the tube during insertion.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your child’s throat may feel sore as the topical anesthetic wears off.
• If your child was given a sedative, he or she may be sleepy for a while until the medicine wears off.
• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level may be monitored until medicines have worn off.
• If your child will be going home with the feeding tube in place, you and your child will be shown how to use it and care for it.

Summary

• A nasogastric feeding tube is a soft tube that is placed through your child’s nose and down into the stomach. This tube is used temporarily to help feed or hydrate your child when he or she is unable to eat, drink, or take medicine by mouth (orally).
• The insertion of the tube may be unpleasant for your child, but most children tolerate having a nasogastric tube fairly well.
• The tube will be removed when your child no longer needs it. If your child will need the tube at home, you and your child will be shown how to use it and check it, and what to do if it comes out.

Nasogastric Feeding Tube Insertion, Pediatric, Care After

This sheet gives you information about how to care for your child after your child’s procedure. Your child’s health care provider may also give you more specific instructions. If you have problems or questions, contact your child’s health care provider.

What can I expect after the procedure?

After the procedure, it is common for your child to have:

• A sore throat.
• Irritated skin on the nose, from the tape used to secure the tube.
• Gagging or nausea. This is more common among older children.
• Some symptoms of gastroesophageal reflux disease (GERD), such as:
  • Abdomen (abdominal) pain.
  • Heartburn.
  • Frequent hiccupping.
  • Irritability during feedings.

Follow these instructions at home:

• Give your child over-the-counter or prescription medicines only as told by your child’s health care provider.
• Always tell your child what you are about to do before handling the tube.
• Always wash your hands before preparing formula or handling the tube.
• Keep the tube clamped except during feedings.
• Follow instructions from your child’s health care provider about how to flush the feeding tube. It will need to be occasionally flushed in order to prevent blockage when it is not being used.
• Allow your child to shower and bathe normally while the tube is in place. Change and reapply the tape that holds the tube in place after each shower or bath. Children whose tubes are secured with a nasal bridle device will not have tape and can shower normally.

Contact a health care provider if:

• Your child coughs repeatedly while the tube is in place.
• Feedings do not pass through the tube as expected.
• The tube comes out completely.
• Your child has stomach cramps.
• Your child has diarrhea or constipation.
• There is redness, irritation, or a blister on the skin around the nose.

Get help right away if:

• Your child has a severe cough.
• Your child feels like he or she is choking.
• Your child has trouble breathing.
• Your child vomits.
• Blood fills the tube.
• Your child has abdominal pain that gets worse.
• Your child’s lips turn blue.
• Your child has a fever.
• Your child has jerky movements that he or she cannot control (seizure).

Summary

• It is important that you and your child know what to do if the tube comes out, gets blocked, or does not function properly.
• Follow the instructions from your child’s healthcare provider about how to give feedings and how to flush the tube when it is not in use.
• Remember to clamp the tube when it is not in use.