A nasogastric (NG) tube is a thin, soft tube that passes through the nose and into the stomach. The NG tube allows your child get the nutrition, fluids or medications that he / she needs. NG tube training sessions must occur for all patients at home with a feeding tube.

Make sure the NG tube is in the right place:

1. Wash your hands with soap and water.
2. Check that the NG tube is in the right place:
• Measure the outside length of the tube and check that this is has not changed. External length = measurement of feeding tube from nostril to base of the hub OR checking the marking on the NG tube, making sure it is right next to the nostril.

AND

• Connect a 5 – 10 ml syringe to the end of the NG tube and pull back to get stomach contents.
• Do not return the stomach contents back in the tube.
3. If you are unable to remove the stomach contents, remove the syringe, close the cover over the end of the tube, and place your child on their left side. After 10 minutes, repeat the attempt to pull back stomach contents into a syringe.
• If you are able to remove stomach contents, discard the contents and proceed with “Give a feeding” (listed below).
• If you are unable to remove stomach contents, remove the NG tube and reinsert tube.

Give a feeding:

1. Wash your hands with soap and water.
2. Gather the supplies:
• Formula / breastmilk
• Bottle or container to measure formula / breastmilk
• 30 or 60 ml syringe
• Small syringe: 5 - 10 ml
• Water
3. Place your child in a position as recommended by your provider. Most patients tolerate feeds better in an upright or side lying position.
4. Remove plunger from the 30 ml or 60 ml syringe.
5. Connect the syringe to the NG tube.
6. Slowly pour the formula / breastmilk into syringe until halfway full.
• Let the formula / breastmilk flow by gravity.
• You may need to put the plunger into the syringe and give a gentle push to get the flow started.
• Then remove the plunger and let formula / breastmilk flow in slowly over 10-20 minutes.
• Continue to add more formula/breastmilk to keep syringe at least half full until full feed is given
• If you lower the syringe, the formula / breastmilk will slow down. If you raise the syringe, the flow will speed up.
7. When the feeding is finished, flush the tube with water to clear the tube with 5-10 ml syringe.
8. Pinch the feeding tube, remove the syringe and close the cover on the end of the feeding tube.
9. Rinse out the syringe with hot water with small amount dishwashing soap and allow to air dry.
10. Clean the end of the end NG tube with a toothbrush and warm water every day.

What other things do I need to remember?

• If your child begins to choke or gag during a feeding, stop the feeding.
• Re-check tube placement.
• Restart the feeding when your child is no longer choking or gagging.
• Know that there is a possibility that your child could throw up and the tube could come out of his / her mouth. If this happens, remove the tape and pull the tube from your child’s nose.
• If your child's stomach becomes large and round or if he / she has discomfort, stop the feeding and wait one hour.
• If the stomach remains large and round or your child continues with discomfort after one hour, call your nurse or doctor.
• Flush the feeding tube with water with a 5-10 ml syringe before and after giving medications as recommended by your provider. This keeps the feeding tube from clogging.
• If you remove the NG tube, pinch the feeding tube so that formula does not drip from the tube and get into your child’s lungs.
• You can re-use the same feeding tube.
• Always check the end of the feeding tube that goes into the stomach for any holes or tears before you reuse it.
• If the feeding tube has a stylet (thin wire that goes in the NG tube during placement), you will need to re-insert the stylet before you reinsert the NG tube.
• It is important to help your child enjoy feeding time. Some tips to help are holding, offering a pacifier for sucking, sitting in a highchair and being at the table for family meals.
• Ask your doctor or nurse about therapy to help improve oral skills.

Call your doctor or nurse if:

• Your child is uncomfortable or fussy with feedings.
• Your child vomits or has diarrhea.
• Your child’s stomach is swollen or bloated.
• You are unable to replace the NG tube.