Patient Instructions: Administering Enteral Tube Feedings

These instructions are for Children’s Hospital of Philadelphia (CHOP) patients who receive formula for nutrition through a feeding tube at home.

Important information about tube feedings:

Your child will be receiving tube feedings at home. There are different types of tubes, but the same instructions can be followed for the care and cleaning of feeding tubes and supplies. Ask your child’s healthcare team if you have questions about your child’s specific feeding tube and supplies.

Instructions for checking pH to confirm placement for NG and OG tubes:

pH is checked to confirm placement for NG and OG tubes. Other feeding tubes, such as G tubes, GJ tubes, ND or NJ tubes do not require checking pH.

For bolus or overnight feeds, check pH before hooking up each feeding.

Attach an oral syringe filled with 5ml of air to the medicine port and push the air in.
Draw back fluid into the syringe.
Check the pH by comparing the pH strip with the color scale. Gastric (stomach) pH should be 1-5.

For continuous feeds, check pH of the tube once a day as long as your child’s condition has not changed.

Stop the feed and flush the tube with the amount of water or air you have been taught.
If your child can handle breaks in the feeding time, pause feeds for 30 minutes prior to pH check.
Flush the tube with 5ml of air and draw back fluid into the syringe.
Check the pH by comparing the pH strip with the color scale. Gastric (stomach) pH should be 1-5.

NG/OG Reminders

Check the pH before giving anything through your child’s feeding tube, such as medicines or formula.
Always check that the mark on your child’s feeding tube has not changed. If the mark has moved, reposition the tube and check the pH.
Always check the pH of your child’s feeding tube if they are not tolerating feeds or medicines or you think something is wrong.
Gastric (stomach) pH should be between 1-5. If the pH is greater than 5 and your child is not having any trouble breathing or changes in behavior, wait 15-30 minutes and recheck the pH.
After rechecking, if the pH is still greater than 5, remove the tube and reinsert it. After reinserting the tube, if the pH is still greater than 5, call your healthcare provider.
For other troubleshooting tips, see Patient Instruction: Inserting NG tube or Patient Instructions: Inserting OG tube.

Instructions to prevent the NG or OG tube from clogging:

Always flush the NG or OG tube before and after each feeding or medicine with the amount of water or air you have been taught.
For continuous feeds, flush anytime you are checking pH, or as needed.
If the tube is clogged, attach a 5ml oral syringe with warm water to the end of the feeding tube. Try to flush the tube. If you are unable to flush, pull back on the plunger of the syringe. Repeat this push and pull action up to 5 times. If you still cannot flush the tube, try using warm water in a 3ml or 1ml oral syringe and repeat the above steps.
After rechecking, if you are still unable to pull back fluid, remove the tube and reinsert it. After reinserting, if you are still unable to pull back any fluid, please call your healthcare provider.

Instructions for preparing your formula for all feeding tube types:

Always start by washing your hands with soap and water or cleaning with hand sanitizer.
Store unopened cans of formula at room temperature.
Keep any open cans or containers of prepared formula in the refrigerator. Throw out the unused formula by date noted on the formula container.

Instructions for positioning during tube feedings:

For children older than 1 year, keep your child’s head elevated about 30-45 degrees while they are getting tube feedings.
Hold your baby under 1 year old on your lap or place them in an infant seat. Speak to your healthcare team about the safest way to position your infant or child during overnight feedings.
Keep all tubing away from your child’s neck. Tubing can be dangerous if it loops around a child’s neck. It could cause them to stop breathing.
Check the position of the tubing often to be sure it is not near your child’s neck. Keep the tubing under your child’s clothing. For example, thread it through the sleeve of their shirt.

Instructions for giving tube feedings using a pump:

The pump is run by electric or battery power and can be made portable by using a backpack.

Program the pump to match the feeding orders from your child’s healthcare provider.
- Rate is how fast the formula will go through the pump and feeding tube and into your child’s stomach. This number is measured in milliliters per hour (ml/hr).
- Dose is the total amount your child will be receiving for the feeding. It is measured in milliliters (mls). The dose is calculated by multiplying the rate by the number of hours the feeding is ordered to run. Example: 25ml/hr to run for 8 hours. The dose would be 25 x 8 = 200ml.
- The pump measures every ml as it passes through the pump and into your child. This amount is called volume. At the start of the feeding the volume is zero. At the end of the feeding the volume will be equal to the dose that was programmed.
Pour formula into the feeding bag.
“Prime” the tubing connected to the bag to clear it of air before connecting to your child’s feeding tube. Place the tubing into the pump and press the “prime” button until no air remains.
Allow feed to run.
When the feeding is done, disconnect the feeding set-up from the tube and flush the tube with the amount of water or air as you have been taught.

Instructions for giving tube feedings by gravity:

Feedings can be given with a syringe with extension tubing or a gravity bag.

60ml syringe:

Remove the plunger.
Attach extension tubing.
Clamp the tubing.
Fill the syringe with formula or human milk.
Open the clamp and allow the liquid to flow through the tubing. This is called priming.
Clamp the extension tubing.
Connect the extension tubing to your child’s feeding tube.
Position the syringe above your child’s stomach.
Adjust the flow of liquid by changing the level of the syringe or the clamp on the tubing.
- The higher the syringe is, the faster the formula will flow in. The lower the syringe is, the slower it will flow in. Generally, it should take 20-30 minutes for the formula to flow in.
- Note the syringe will only hold 60ml at one time. If your child’s feeding amount is greater than 60ml, add more formula to the syringe as it begins to empty.
When the feeding is done, disconnect the feeding set-up from the tube and flush the tube with the amount of water or air you have been taught.

Gravity bag:

Close the clamp on the tubing.
Fill the bag with the amount you need for the feeding and close the lid on the bag.
Open the clamp and allow the liquid to flow through the tubing. This is called priming.
Close the clamp.
Attach the tubing to your child’s feeding tube.
Hang the bag above your child’s stomach.
Adjust the flow of liquid by changing the level of the bag and the clamp on the tubing.
- The higher the feeding bag is, the faster the formula will flow in. The lower the feeding bag is, the slower it will flow in.
When the feeding is done, disconnect the feeding set-up from the tube and flush the tube with the amount of water or air you have been taught.

Instructions for cleaning your tube feeding supplies:

Feeding bags and syringes must be cleaned as directed. To clean the supplies:

Empty any extra formula into the sink.
Fill the bag or syringe with warm water, rinse, and pour out the water. If it is difficult to get the bag or syringe clean, rinse it through with water 2-3 times.
Once the bag or syringe is clean, fill it with warm water again and let the water run through the tubing until the tubing is clear.
Hang all feeding bags to dry with the cover and roller clamps open. Syringes and tubing should be separated and left on a clean paper towel to dry.
Follow your homecare company’s instructions for cleaning and changing the feeding bag or syringe.

Instructions for cleaning the feeding pump:

Turn off the pump and disconnect the pump from the power source before cleaning.
Wipe the outside surface of the pump with a damp cloth or sponge.
Clean the drop sensors of the pump with damp cotton swabs or Q-tips^®. Follow the manufacturer’s cleaning instructions.
Do not put the pump in water or any type of cleaning solution.

Call your healthcare team if you have questions, concerns or if your child:

Has watery stools or diarrhea.
Is constipated.
Is vomiting repeatedly with feeds.
Is experiencing bloating or belly pain.
If you have any questions or concerns about your child’s feeds or feeding tube.

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.