Tube feeding your baby

This information has been written for parents and carers who have a baby being fed by nasogastric tube as part of their treatment on the Neonatal Unit. Our aim is to help you understand why your baby needs tube feeds, how it is done and how long it is likely to be needed.

Your baby requires to have their feed via a nasogastric tube because they are unable to feed completely by breast or bottle. On the Neonatal Unit, we like to encourage parents and carers to be as involved as much as possible in the care of their babies. The Neonatal team will teach you to give tube feeds whilst your baby is in hospital. At first this may sound a little daunting, but you will be well supported throughout the process.

How will I be prepared for tube feeding?

We will begin to teach you how to give tube feeds when your baby is stable, so that you can be involved as much as possible in your baby’s care. We will explain what to do step by step and let you practice along the way. To make sure that we tell you all you need to know without leaving out important details, we will complete a checklist of points to remember and things to discuss.

You will be able to practice tube feeding whilst being observed by the nurse helping you to look after your baby until you feel confident to do the tube feeds yourself. Teaching will progress as slowly or as quickly as you decide so that you can learn properly and gain confidence.

Why does my baby need tube feeds?

If your baby was born early he or she is not yet fully developed. A baby in the womb only develops the ability to suck when he or she has reached 32 weeks gestation and is not able to coordinate sucking, swallowing and breathing all at the same time, until around 34 – 36 weeks gestation. Sometimes this may take longer and your baby will need help with feeding if he or she is to get enough calories and other nutrients to make sure they grow and develop. If your baby was born full term the reasons they cannot feed orally will be discussed on an individual basis.

When your baby starts to have milk feeds, they will progress from hourly to less frequent feeds which will be put down a feeding tube. This is a thin tube passed down either a nostril or through the mouth until its tip lies in the stomach. It is secured to the baby’s cheek with tape and has an opening covered by a lid at the outer end so that a syringe can be attached to it to give the feed. The feed is allowed to drip slowly down the tube by gravity into the stomach.

Tube feeding diagram

Your baby will eventually start to feel hungry and may show an interest in feeding by rooting with his or her mouth. The Neonatal team will inform you when your baby is ready to try some breast or bottle feeds. To begin with your baby may tire quickly as they learn to feed, this will improve once they are bigger and stronger.

Although your baby may take some feeds by mouth the remaining feed will be given via the nasogastric feeding tube to allow your baby time to rest and grow. The Neonatal team will calculate how much milk your baby needs and how often, this is worked out on an individual basis.

Giving a tube feed

Step 1. Wash and dry your hands

Step 2. Prepare the equipment

You will need:

Measured amount of correct feed, warmed to room temperature
___ ml syringe for aspirating the feeding tube
___ ml syringe for giving the feed
pH indicator paper/strips

Step 3. Check the position of the feeding tube using the pH indicator paper/strip
To do this, attach the syringe to the feeding tube and gently draw back a small amount of fluid and place onto the pH indicator paper/strip. If the pH paper changes to a pH 5 or below this means the tube is in the stomach, move on to step 5. If the pH is above 5 seek support from the nursing team.

Step 4. If no fluid can be obtained or pH above 5, the stomach may be empty or the tip of the tube may be against the stomach wall. Try injecting 0.5 – 1.0ml of air into the tube and then gently draw back again. If there is still no fluid try repositioning the baby by laying him/her on right side for a few moments and try again.

If you are still unable to get any fluid or are worried about the position of the tube, seek support from the nursing team.

Step 5. When you are sure that the tube is in the right place, remove the plunger from the larger syringe and attach to the feeding tube. Pour some milk into the syringe. If the milk does not flow freely down the tube, it may need a gentle push to get the flow started. Once the flow has started the plunger must be removed to stop the milk flowing to quickly into the stomach. Do not hold the syringe too high as this will make the milk run quicker which may cause vomiting. Continue adding milk until the right amount has been given. Do not allow the syringe to become empty.

Step 6. The syringe of milk should be hand held throughout the feed. This way you will be able to observe your baby during its tube feed in case of vomiting or accidental removal of the tube whilst the feed is in progress. If your baby is retching, lower the syringe to slow the feed or stop and rest until your baby is settled and restart the feed. If your baby vomits stop the feed, if the tube is accidentally removed during the feed it should not be replaced until the next feed is due. If your baby is at home please seek advise from the community nursing team.

Step 7. When the feed is completed, remove the syringe and replace the feeding tube lid securely. Wind your baby and position as appropriate for your baby’s individual needs. To reduce vomiting you can hold your baby in an upright position for 20 minutes after their feed. Do not bounce your baby after a feed.

Step 8. Dispose of the equipment and wash your hands.

Step 9. Write all the feeding information on your baby’s feed chart and sign your name.

Step 10. Whilst your baby needs tube feeds he/she will need some mouth care, discuss this with your nurse. If your baby has a feeding tube down his/her nostril, it is also important to look at your baby’s nose before each feed to check for redness as this may be caused by the feeding tube rubbing the side of his/her nostril.

Tube feeding your baby – advice

Point Number 1.

If your baby is having syringe feeds, then the amount of feed can be measured using the syringe as it is poured in or it can be measured out into a bottle with the numbers of millilitres on the side.
If your baby is having pump feeds, then the amount of feed will be calculated into the pump to ensure the correct amount is given for each feed.

Point Number 2.

Milk can be given at room temperature if a ready-made formula.
If you need to warm the milk then you can check the temperature by squeezing a small amount of milk out of the bottle (via the teat) onto the inside of your wrist to ensure it is not too hot. If milk is too hot the bottle can be placed under the cold water tap for a few moments to cool it down.

Point Number 3.

If the pH measures above 5, this could be the result of anti-reflux medications and you should discuss this with your nurse before giving the feed.
If your baby is having some oral feeds, then a bottle or breastfeed can be offered first and then an aspirate can be obtained after this feed to confirm the position of the tube by retesting the pH.
If your baby is nil by mouth, then giving some mouth care could help to obtain an aspirate to test the pH.

Tube Feeding Your Baby – Troubleshooting Points

Troubleshooting Point Number 1

If baby is having gravity feeds then the amount of feed can be measured by the syringe as it is poured in or it can be measured out into a bottle with the numbers of millilitres on the side.

If baby is having pump feeds then the amount of feed will be calculated into the pump to ensure the correct amount is given for each feed.

Troubleshooting Point Number 2

Milk can be given at room temperature if it is a ready-made formula.

If you need to warm the milk you can check the temperature by squeezing a small amount of milk out of the bottle (via the teat) onto the inside of your wrist to ensure it is not too hot. If milk is too hot then the bottle can be placed under the cold water tap for a few moments to cool it down.

Troubleshooting Point Number 3

If pH 5.5 and above. This could happen regularly if the baby is on anti-reflux medications, due to the nature of this medication, you can discuss this further with your nurse.

If the baby is having some oral feeds, a bottle or breastfeed can be offered and an aspirate obtained after this feed to confirm the position of the tube.

If baby is nil by mouth, then giving some mouth care could help as this stimulates gastric secretion of acid.