Babies and Children Nasogastric Tube Feeding

Nasogastric tubes (NGT) are small tubes that pass through the nose, down the back of the throat and into the stomach (tummy). They are often used to allow babies and children, who have difficulty swallowing or feeding, to receive liquid nutrition to maintain hydration and nutrition.

Tube feeding is a way of giving your child nutrition and fluids in a liquid form. Depending on your child’s condition this may be the only way you can feed your child or it may be a way of supplementing your child’s oral intake (feeds).

The dietician will be able to advise you on the amount and type of feed and how much additional water your child needs in order to maintain health. The dietician will also instruct you as to how long the feed should be given over.

When your child leaves hospital you will be given a supply of equipment and feed to take home. Once home supplies of syringes and feed bags will be delivered to your home via a feed care company or via the CCNT. Specialist milk feeds may also be delivered in this way or you may need to collect this from your local pharmacy (as a repeat prescription) depending on the type of milk feed your child needs.

Before your child leaves hospital you will be taught how to look after the tube and give feeds and/or medications. Once home the childrens community nursing team will be able to provide you with support and advice regarding the system of feeding. In addition they will also be able to help with any problems with the tube. Depending on the material your child’s tube is made of, the tube will need replacing either every 1-2 weeks or every 1-2 months.

The home care delivery company are available via the telephone 24 hours a day, seven days a week, and can give advice on pump related problems. The home care delivery team may also provide some of the training for you/your child’s school/nursery.

Once home, the hospital dietician will contact you to see how you are getting on with the feeding regimes and amend the regimes as necessary. The frequency of contact from the dietician will depend on your child’s clinical needs.

• It is important that you always wash your hands with hot soapy water, rinse and dry before handling your child’s tube
• Harmful bacteria in the feed can make your child unwell, so it is important that the feed is stored in the correct way
• Most feeds do not need to be stored in the fridge until they are opened but you should check with your child’s dietician if you are unsure. All liquid feeds will need discarding 24 hours after opening
• To reduce the risk of cross infection nurses/carers/teachers should wear disposable non- sterile gloves when handling your child’s tube.

In the hospital environment syringes can only be used once. However, once home you will be able to re-use the syringes.

Between uses you will need to wash thoroughly in hot soapy water, rinse and leave to dry. The syringes can be cold sterilised after washing for those children who are immunocompromised or are less than one year of age.
Feed bags should be discarded after 24 hours of use.

Tap water can be used to flush through the tube or for fluid bolus’ except if you child is under one or immuno- compromised. In these cases cooled boiled water should be used. Never use filtered or bottled water.
Powdered feeds should be made up as directed on the manufacturers instructions.

Your child’s NGT must be checked prior to the administration of a feed or medication. It should also be checked after any retching, gagging or vomiting.

The most reliable way to check the position of the tube is to measure the pH (acidity/alkalinity) of your child’s stomach contents using pH indicator strips or paper. These have a colour code chart indicating the colour change of each pH reading from pH 1 (acid), through pH 7 (neutral) to pH 14 (alkaline).

The contents of your child’s or baby’s stomach are normally acidic. The most reliable way of being sure that the tube is in the stomach is by carrying out a pH test on the fluid retrieved from the tube. If the tube is in the stomach, the fluid will normally have a pH of 5 or below. You will be taught how to safely check your child’s tube.

Be aware that some medicines may block the tube and others may not suitable for crushing. If this applies to your child’s medication you will be informed before you leave hospital and advised how to give such medication. The position of the tube must be checked by checking the pH before each use.

You will need:

1. pH strip
2. Empty purple syringe
3. Water in a purple syringe
4. Medication drawn up in purple syringe

Method:

• Wash and dry your hands.
• Test the tube – to do this attach the empty syringe onto the tube and aspirate back until fluid is seen in the syringes 1 ml should be a sufficient amount to test. Drip the contents of the syringe onto the pH paper. Compare the colour of the pH paper to the chart you have been given. Usually the paper should test less than 5 however if your child has anti-reflux medication a pH of below 6 may be acceptable. Check with the nurse if you are unsure. Do not use the tube if you are unable to aspirate the tube or the pH of the aspirate is above 6.
• Assuming the pH is within the acceptable range the medication can be given slowly by pushing the plunger down. If the medication is very thick you may need to give a small flush with water then give the rest of the medication.
• Once all the medication is given the NGT should be flushed with at least 5mls water.
• Replace the cap of the tube.

Never mix medicines together in the same syringe unless advised to do so by the pharmacist. Always flush through your child’s tube with water between different medicines.

You will need:

1. pH strip
2. Empty syringe
3. Feed
4. Water filled syringe
5. Large syringe – plunger removed (your nurse will tell you the appropriate size to use).

Method:

• Wash and dry your hands.
• Test the tube – to do this, attach the empty syringe onto the tube and aspirate back until fluid is seen in the syringes, 1 ml should be a sufficient amount to test. Drip the contents of the syringe onto the pH paper. Compare the colour of the pH paper to the chart you have been given. Usually the paper should test less than 5, however, if your child has anti-reflux medication a pH of below may be acceptable check with the nurse if you are unsure. Never feed your child if you cannot aspirate the tube or the aspirate is above a pH of 6.
• Connect the large syringe to the end of the NGT; pour feed into the tube until all the feed is gone. The feed will be delivered by gravity so if you want to slow the feed down hold the syringe lower and vice versa. You should be aware that giving the feed too quickly may cause your child to vomit. If the feed does not appear to be going down the tube place the plunger into the top of the syringe then remove, this may help to get the feed started.
• A NGT feed should take approximately 20 minutes (the same as for an oral feed).
• For babies it is advised that they are placed on their right side whilst they are receiving their tube feed. You may also want to use a dummy during the feed which helps your baby associate a sucking action with the feeling of being full.
• Occasionally the feed starts to come back up the tube if there is increased abdominal pressure, e.g. crying. If this happens place the plunger over the top of the syringe while you try to console your baby/child. Once they have settled, the feed should continue as before (although you may need to give the plunger a slight push to get it started again).
• If your child/baby starts coughing or choking, stop the feed by emptying the syringe of milk/formula back into the bottle and disconnecting the syringe. Replace stopper and observe and assess the child/baby. Reset the tube before re-starting the feed
• Once the required volume of feed has been delivered flush through the line with at least 5 ml of water- your dietician will be able to advise you if a larger flush is required.
• If your baby/child is receiving a thickening agent in their feed, it can take longer to go down. If this becomes a real problem they may need to have a larger size tube inserted. If your child is receiving Gaviscon this may also lead to thickening of the feed. Please talk to your nurse if this becomes a problem.

You will need:

1. pH paper
2. Empty syringe
3. Pump and stand/rucksack
4. Feed
5. Giving set
6. 2 x water filled syringes

Method:

• Wash and dry your hands.
• Test the tube – to do this attach the empty syringe onto the tube and aspirate back until fluid is seen in the syringes 1 ml should be a sufficient amount to test. Drip the contents of the syringe onto the pH paper. Compare the colour of the pH paper to the chart you have been given. Usually the paper should test less than 5 however if your child has anti-reflux medication a pH of below 6 may be acceptable check with the nurse if you are unsure. Never feed your child if you cannot aspirate the tube or the aspirate is above a pH of 6.
• Flush the tube with 10ml of water or other volume as advised by your dietician.
• Put the giving set into the pump and onto the stand/rucksack.
• Fill the giving set with the required volume of feed/fluid.
• Prime the giving set using the prime button on the pump to within a cm from the end of the giving set.
• Set the pump rate and total volume.
• Attach the giving set to the feeding tube and set the pump to run as you have been shown.
• For any alarms during feeding see the pump information leaflet for help.
• At the end of the feed flush through your child’s line with at least 10ml water.
• Close the NGT cap.

Reposition your child – for example sit them up, lay them down etc. Then retest the tube.
If your baby or child can take some oral fluids, encourage them to take a little then try to test the tube again after 10 minutes. If you have still not obtained any aspirate, advance the tube by 1-2cm and try again.

Check the tube is in the same position. Both long and short term tubes have numbers on them indicating how many centimetres the tube has been passed to. If the tube has partially come out it may need replacing by the nurse. If no aspirate can be obtained, contact the Childrens Community Nursing Team or Children’s Acute Referral Unit – contact numbers are at the top of this digital leaflet.

• Do not feed your child if you are unsure of the reading between pH 5 and 6.
• If your baby/child has just had a feed or is on continuous feeds, the milk in the stomach can increase the pH of stomach contents (they become more alkaline). If your baby/child is on medication which reduces the acid in the stomach, you may also get a pH reading of more than 5.5.

If a pH of more than 5.5 is measured:

• for continuous feeds, stop the feed, wait for up to one hour and test again
• for feeds given at regular intervals (known as bolus feeds), wait for up to one hour after feeding and test again.

If the pH remains above 5.5 and you have not previously discussed with the childrens community team, do not proceed until advice has been given.

• From time to time the tapes on your child’s face may need changing.
• If your child is at home the tapes will be provided by your GP via prescription. Your Children’s Community Nurse wil advise the GP of the dressings to be prescribed.
• If your child is still in hospital a nurse will help you replace the tapes.
• Before the tapes are changed it is advisable to note the length your child’s tube has been passed to, this will be shown in centimetres on the tube.
• First cut the tapes using clean scissors to the required size, cut the tapes so they have rounded edges as they are less likely to lift up. Ask your child/ someone else to hold the tube at the nose. Carefully remove the old tapes, clean the skin if necessary and reapply the tapes, ensuring that the tube measurement reads the same as when you started. Care should be taken to ensure the skin is clean and dry before the new tapes are applied, failure to do so will mean the new tapes will not stick sufficiently.

• Between the hours of 9am-5pm, seven days a week the children’s community nursing team can be contacted on the number on the front of this leaflet.
• At all other times you should call the children’s assessment unit on the number on the front of this leaflet.
• If you are still in hospital inform the nurse that is caring for your child as soon as possible.
• Never attempt to re-pass the tube yourself unless you have had the specific training to do so, and you are signed off as able to complete this procedure. Attempting to pass the tube without adequate training may prove life threatening to your child.

Having a NG tube will enable your baby/child to receive liquid nutrition or fluids that are vital for growth, development and hydration Most liquid medication can also be given via a NG tube.
Your child’s nurse will inform you if your child cannot receive medication in this way.

The main risk associated with an NG tube is that it may be displaced and feed could accidentally go into the lungs rather than the stomach, causing serious harm or infection.

Displacement may occur without your baby/child showing any outward signs. Therefore to reduce the risk it is vital that the position of the tube is checked each time before you use it.

There is no short-term alternative if your child cannot swallow safely or cannot take enough nutrition for adequate growth and development. If your child continues to need the NG tube, alternatives will be discussed with you.

Your Children’s Community Nurse will advise you when the tube will need replacing. This will be between 1-2 weeks and 1-2 months.

Children Community Nursing Team (CCNT) 01206 286585, Monday-Sunday 9am-5pm

Children’s Assessment Unit 01206 746200

Children’s Ward 01206 746208 or 01206 746209

Do not attempt to re-pass the NG tube yourself unless you have been trained to do so.

Your nursing team will provide you with the following written information

1. Whether your baby or child has a short term or a long term tube.
2. How frequently this tube will need changing.
3. The tube length at the nostrils in cm.

If you do not have this information, please ask for it.

When you attend hospital you will be asked for your child’s NHS number and other information such as your address. Please be patient with this procedure – it is to ensure our records are kept up to date and to protect your safety. However, if you do not know your NHS number, please do not worry – you will still receive care!

Please raise any concerns in the ward or department you are in. Ask to speak with the ward sister, matron or department manager. If your concerns cannot be resolved or you wish to make a formal complaint, please call PALS (Patient Advice & Liaison Service) on 0800 783 7328, or pick up a PALS leaflet.

If you or a family member has recently been in Colchester General Hospital, you can tell us about your experience by searching for ‘Colchester’ on the NHS Choices website (www.nhs.uk), by writing to the address on the front of this leaflet, or by filling in a ‘Friends and Family’ questionnaire at the hospital.