What is a naso-gastric tube?
A naso-gastric (NG) tube is a thin, plastic tube that is inserted into one of your child’s nostrils, down the back of the throat into the stomach.
NG tubes are often used to feed children who cannot, for various reasons, eat or drink normally by mouth. A child may use an NG tube to feed for a short while after an operation or on a longterm basis if he or she has problems swallowing.
Some children cannot get enough goodness from food they eat, so use an NG tube to ‘top up’ their nutrition. Some children’s blood sugar level drops dramatically while they are asleep and NG tube feeding overnight might be used to correct this. although on a long term basis, a gastrostomy might be a safer method.
What are the advantages and disadvantages of an NG tube?
- Provides a safe method for feeding
- Can be removed when not in use
- No anaesthetic needed for insertion
- Can appear unsightly
- Insertion can sometimes be a battle
- Can be dangerous if inserted into the airway instead of the foodpipe.
How is it inserted?
The nurses on the ward usually insert NG tubes. The length of tube needed for each child is different, so the nurse will measure the correct length before inserting it. The nurses will insert the tube into one of your child’s nostril, down the back of the throat into the foodpipe until it reaches the stomach.
If a child is able to drink fluids safely, a drink of water sometimes makes it easier for the end of the tube to travel to the stomach. Inserting the tube does not hurt, but it may be uncomfortable for a short while. It may make your child sneeze, cough, retch, tickle their throat and makes their eyes water.
If you feel comfortable about inserting your child’s NG tube at home, we will teach you how to do it. If you do not feel comfortable, we can make arrangements with your local community team or local hospital to insert it when needed.
Checking the position
It is important to check that the NG tube is in the correct place in the stomach. The foodpipe and airway separate from each other below the voicebox and there is a small risk that the NG tube could end up in the airway instead of the stomach.
The nurses will check the position of the tube by using a syringe connected to the end. If no fluids are sucked in to the syringe from the stomach, it may not be correctly placed. If fluids are sucked up, these are put on a piece of pH paper. If the paper indicates a pH of less than five, the tube is in the stomach as the stomach contents are acidic.
If this method is not possible for any reason, it is possible to check the position of the NG tube by taking a chest X-ray.
Securing the tube
Once the NG tube is in the right place, the nurse will secure it to your child’s cheek using tape. While the NG tube is not being used, the end will be closed with a special cap. This reduces the risk of infection.
Are there any risks or complications with NG tubes?
The main risk with inserting the NG tube is that your child could have a nosebleed when the tube is inserted into the nostril. This tends to happen more with children who have nosebleeds anyway.
There is also a risk that the NG tube could enter your child’s windpipe instead of the foodpipe, but this becomes obvious when the position of the tube is checked with pH paper, and the tube can be removed without causing damage. The position of the tube must be checked before each feed, as it can be dangerous for feed to enter the windpipe and lungs. Even if the tube is inserted into the right place, it can change position afterwards.
There is a small risk that the NG tube could damage your child’s gullet, but this is very unlikely as the tube is flexible.
How will my child feed using the NG tube?
Your dietitian will discuss with you the most appropriate method of feeding your child. This depends on your child’s medical condition, and the particular needs of your child and family and your home circumstances. There are three different methods of feeding your child using the NG tube - bolus (intermittent), continuous or a combination of both, for example, bolus feeds during the day and a continuous overnight feed.
A bolus is a specific amount of feed that is given in one go, usually over about 10 to 20 minutes. If your child is being fed continuously, he or she will receive the feed slowly over a number of hours through an electric pump. The pump contains a rechargeable battery pack, so it can be put into a backpack when your child is out and about; when your child is at home, the pump should be plugged in so the battery can recharge.
Your child will have a specially prepared liquid feed, which contains all or most of the nutrients he or she needs. Please talk to your dietitian if you would like to know more about it. Some children can continue to eat regular food by mouth, using the NG tube to ‘top up’ his or her nutrient levels, but this depends on the reason why the tube is required.
Remember that only prescribed feeds and medicines should be put down the tube.
When will we be taught how to deal with the NG tube?
The nurses on the ward will start to teach you how to look after the NG tube and give your child feeds through it soon after it is inserted. Your community team will also be involved and the ward dietitian will teach you how to make up the feeds if this is needed. There will be a lot to learn but we will make sure you are confident before you go home. Although it may feel daunting at first, it will quickly become easier. Remember that there is always someone on the end of the telephone in your local area to advise and reassure you.
Before you go home, you should feel confident about all of the things on the checklist on the back page.
When can we go home?
As soon as your child is feeding well using the NG tube and you are confident about looking after the tube, you will be able to return home.
Will my child need to keep the NG tube in all the time?
This depends on the reason why your child needs an NG tube and how you feel about inserting a new NG tube. Some children, particularly if they only have overnight feeds, prefer to remove the tube during the day and re-insert it every night. Other children prefer to leave the NG tube in place all the time.
Often, a child’s preference changes as he or she grows older and becomes more aware of looks and body image. Please talk about this to your nurse. Even if you decided not to insert the tube at first, we can still teach you (or your child if old enough) to do it, months or years later.
What sort of support can I expect when I get home?
Your local community health care team will be able to help you. This may be your local paediatric community nurse if your area has one, your local GP surgery or local children’s ward. If you have any worries, you can always ring your community team for advice and support.
How do I look after my child’s mouth?
Your child should still continue to clean his or her teeth twice a day, especially if not eating anything by mouth and visit the dentist regularly.
Where do I get the equipment and supplies?
We will give you a spare NG tube to take home with you. You will get further supplies from your community health care team, your local paediatric community nurse (if your area has one), your local dietitian or your GP. You should remember to order new supplies in good time, before you run out, and only use equipment for the length of time specified by the manufacturer.
Using or re-using equipment against the advice of the manufacturer could lead to infections, causing a nasty bout of diarrhoea and vomiting which could harm your child. If you have any problems getting hold of supplies, please ring the nutrition team at Great Ormond Street Hospital (GOSH).
What should I do about medicines?
When doctors prescribe medications, remind them that your child uses an NG tube. Tablet or capsule particles may block your child’s NG tube, and so liquid medications are better.
If you need to give medications in tablet form, make sure they are finely ground and mixed with cooled, boiled water. You can buy a tablet crusher from your local community pharmacy to make this easier. You should flush the NG tube well after giving any medication, as shown on the ward.
Can my child have a shower or bath?
As long as the cap on the end of the NG tube is secure, your child will be able to shower or bath safely. If the tape securing the NG tube becomes damp, you will need to secure it with a new piece of tape afterwards.
Will my child be able to go to school?
Your child should be able to go to school as normal. Your community team, social worker or special educational needs co-ordinator (SENCo) at the school will be able to advise you further about this.
What about swimming or PE?
Your child will be able to go swimming as long as the NG tube is secured with a special waterproof dressing. The tape you normally use will soak off when wet, which could lead to the tube falling out. It may be a good idea to avoid contact sports, like rugby, to prevent the tube being accidentally pulled. If your child particularly enjoys contact sports, ask the medical team for advice.
Will we be entitled to any extra benefits?
You may be entitled to social security benefits. Please ask to speak to a social worker about this.
Can we go on holiday?
It is fine to travel with your child. However, if your child has complex needs, you should discuss your travel plans with the doctor. Remember to take extra supplies with you, in case you end up staying longer than planned. If you are planning to fly to your holiday destination, remember to carry some equipment in your hand luggage, in case your suitcases go missing. You should also carry a letter from your consultant explaining that you are carrying medical equipment because of your child’s feeding needs. This should prevent any problems with airport security.
If you want to travel abroad with your child, please contact PINNT (Patients on Intravenous and Nasogastric Nutrition Therapy). They can provide you with information on how to arrange insurance, get supplies abroad if necessary and other useful information.
It may be helpful, particularly if your child has other complex needs, to take a letter from the relevant consultant at GOSH explaining your child’s medical history. This will help if you need to seek medical advice locally.
How are we all going to feel about NG feeding?
You, your child and the rest of the family may feel from time to time that you are tired of NG feeding. It affects every family in a different way, but the following are problems that commonly crop up. If you would like to talk through any of the following, please contact your child’s paediatric community nurse who will be very happy to help.
Keeping things normal
Try to treat your child as normally as you can. Children who are over-protected or treated differently can become demanding. Your child is only ‘different’ in the way he or she feeds. Your child will be happier if rules stay the same and life carries on much the same as before.
When you leave hospital, you may find your child is more demanding than usual. This is a common reaction to being in hospital, so you should expect it. Your child may become more clingy or revert to earlier behaviour, such as bed wetting, until he or she is used to being at home with you again. If you are worried about your child’s behaviour, please talk to you GP or community paediatrician. They may be able offer you help and advice about settling back into a normal routine once your child returns home.
Your child may feel self-conscious about his or her tube. Talking to other people can help - you could try contacting the support organisations listed at the end of this leaflet for support and advice.
Feeling tied down by the feeding routine
Your child, you and the rest of your family may feel that everything has to revolve around feeding. Keeping to your normal routine as far as possible – by maintaining the usual mealtimes and bedtimes for example – may help.
If you have other children, they may feel upset at the attention their brother or sister is receiving. Having ‘special time’ with your other children may help. If relatives and friends seem to focus on the child who has an NG tube and pay less attention to your other children, you could ask them to treat all your children equally.
Will my child ever be able to feed by mouth again?
This depends on the reason why your child needed the NG tube. Your team will discuss with you if and when they would like your child to try feeding by mouth again. At first, your child may have ‘forgotten’ how to eat and drink by mouth. If this is the case, our feeding nurse specialist will offer advice and support.
Some children continue to need tube feeding on a long term basis in which case we usually recommend a gastrostomy, which is a tube that goes directly into the stomach. Your clinical nurse specialists will explain about gastrostomies.
Please note: If your child has an endocrine or metabolic condition, you should discuss troubleshooting with your clinical nurse specialist or doctor before following the advice below.
Your child feels sick and has stomach cramps
Check the rate of feeding. Ring your community team for advice as you may need to slow down the feeding rate. The feed may be too cold. Let the feed reach room temperature and then give to your child.
Your child has diarrhoea
Check the rate of feeding. Ring your community team for advice as you may need to slow down the feeding rate. If diarrhoea continues, please contact your doctor.
Your child is vomiting
Check the rate of feeding. Ring your community team for advice as you may need to slow down the feeding rate. The feed may be too cold. Let the feed reach room temperature and then give to your child. If your child is still vomiting, draw up a sample of his or her stomach contents and contact your family doctor (GP).
Your child’s stomach is swollen and hard after feeding
‘Vent’ or remove wind in the way you have been shown.
The pH paper does not indicate a pH of less than 5 when I test before a feed
The tube is probably in the wrong place. Either: remove and re-insert the tube if you have been taught to do this or contact your community team for advice.
The tube seems to be blocked
This may be due to inadequate flushing or a very thick feed or medicine. Try flushing the tube with warm water or fizzy soda water and hold the tube high so that the water moved more easily.
The tube falls out
Either remove and re-insert the tube if you have been taught to do this or contact your community team for advice. If the tube falls out at night, you should take your child to your local hospital. Please bring your spare tube with you.