Nasogastric Tube in Children
Essential information for parents, caregivers, and healthcare professionals
Introduction
A nasogastric tube (NG tube) is a thin, flexible medical tube that is inserted through the nose, down the throat, and into the stomach. In pediatric care, NG tubes serve critical functions including feeding, medication delivery, and stomach decompression. This guide provides comprehensive, practical information about NG tubes in children to help parents, caregivers, and healthcare professionals understand their use, care, and safety.
Purpose and Medical Uses
Nasogastric tubes serve several important medical purposes in pediatric care:
- Nutritional Support: Delivering liquid nutrition to children who cannot eat normally due to medical conditions, surgery, or swallowing difficulties
- Medication Administration: Giving medications to children who cannot swallow pills or liquid medicines
- Gastric Decompression: Removing gas, fluids, or contents from the stomach to relieve pressure or bloating
- Stomach Emptying: Draining stomach contents before or after surgery
- Sample Collection: Obtaining stomach contents for laboratory testing
Where NG Tubes Are Used
- Hospitals (pediatric wards, intensive care units, emergency departments)
- Outpatient clinics
- Home care settings (with proper training)
- Rehabilitation centers
- Long-term care facilities
Types of Nasogastric Tubes
| Type | Description | Common Uses |
|---|---|---|
| Single-Lumen NG Tube | Has one channel for feeding or draining | Feeding, medication administration, gastric drainage |
| Double-Lumen NG Tube (Salem Sump) | Has two channels - one for drainage and one for air vent | Continuous gastric decompression, preventing tube collapse |
| Weighted NG Tube | Has a small weight at the tip to help positioning | Patients with reduced gastric motility |
| Fine-Bore NG Tube | Thinner, more flexible tube | Long-term feeding, more comfortable for children |
| Large-Bore NG Tube | Wider diameter tube | Gastric lavage, rapid drainage, emergency situations |
How to Use: Step-by-Step Insertion Guide
Preparation
- Gather Supplies: NG tube (correct size), water-soluble lubricant, 60ml syringe, pH test strips, tape or securing device, gloves, stethoscope, cup of water (for older children), tissue
- Explain the Procedure: Talk to the child in age-appropriate language. For infants, speak calmly. For older children, explain what will happen and how they can help
- Position the Child: Sit upright or semi-upright position (45 to 90 degrees). For infants, swaddling may help. Have another person assist with holding if needed
- Measure the Tube Length: Measure from the tip of the nose to the earlobe, then down to the point halfway between the xiphoid process (bottom of breastbone) and the umbilicus (belly button). Mark this length on the tube
Insertion Procedure
- Put on Gloves: Maintain hygiene and infection control
- Lubricate the Tube: Apply water-soluble lubricant to the first 10-15 cm of the tube tip
- Insert Through Nose: Gently insert the tube into the nostril, aiming straight back (not upward). Advance slowly and steadily
- Advance the Tube: When the tube reaches the back of the throat, ask older children to swallow or sip water. For infants, offer a pacifier. Continue advancing to the marked length
- Check Placement: This is critical for safety. Use multiple methods including aspirating stomach contents, checking pH (should be 5.5 or less), listening with stethoscope while injecting air, and confirming with X-ray when required
- Secure the Tube: Use medical tape or a specialized securing device to fix the tube to the nose and cheek. Ensure it is comfortable and not pulling
Daily Care and Maintenance
Feeding Through NG Tube
- Always check tube placement before each feeding
- Flush the tube with water before and after each feeding or medication
- Use room temperature formula or food
- Feed slowly (over 20-30 minutes for bolus feeding)
- Keep the child upright during and 30-60 minutes after feeding
Tube Care
- Clean around the nostril daily with warm water and cotton swab
- Check the tube position marking daily to ensure it has not moved
- Flush the tube with water every 4-6 hours if not in use to prevent clogging
- Replace tape or securing device regularly (every 2-3 days or when soiled)
- Alternate nostrils if tube needs to be reinserted (typically every 2-4 weeks or as directed)
Mouth and Nose Care
- Provide regular mouth care even if not eating by mouth
- Keep lips moisturized with lip balm
- Clean nasal area gently to prevent irritation or infection
- Monitor for pressure sores on the nose
Precautions and Potential Dangers
Serious Risks to Watch For
- Aspiration: Formula or medication entering the lungs instead of stomach. Can cause pneumonia or choking
- Tube Misplacement: Tube entering the airway (trachea) instead of esophagus. This is life-threatening
- Perforation: Rare but serious injury to the esophagus, stomach, or other structures
- Tube Migration: Tube moving out of position after placement
Common Complications
- Nasal Irritation: Redness, soreness, or bleeding from the nostril
- Throat Discomfort: Sore throat, gagging, or difficulty swallowing
- Nausea and Vomiting: Especially if feeding too quickly
- Tube Blockage: From thick medications or inadequate flushing
- Skin Breakdown: Pressure sores where tape secures the tube
- Sinusitis or Ear Infections: From prolonged tube placement
- Electrolyte Imbalance: From excessive drainage or inadequate nutrition
Safety Measures
- Always verify tube placement before each use
- Never force the tube during insertion
- Monitor for signs of respiratory distress during and after insertion
- Keep the feeding bag and tubing clean to prevent infection
- Do not use the tube if it appears damaged or kinked
- Follow prescribed feeding schedule and amounts exactly
- Keep emergency contact numbers readily available
- Difficulty breathing, coughing, or choking during or after tube insertion
- Blue color around lips or face
- Tube comes out completely
- Severe abdominal pain or distension
- Vomiting blood or dark material
- Fever above 38.5 degrees Celsius (101.3 degrees Fahrenheit)
- Signs of dehydration (dry mouth, no tears, decreased urination)
Frequently Asked Questions
How long can an NG tube stay in place?
Typically 2-4 weeks for standard tubes, though some fine-bore feeding tubes can remain longer. The healthcare provider will advise on replacement schedule. Long-term feeding usually requires a gastrostomy tube (G-tube).
Is NG tube insertion painful for children?
It is uncomfortable but should not be severely painful. Children may experience gagging, tearing, and temporary discomfort. Proper technique and calming measures help minimize distress.
Can my child eat or drink with an NG tube in place?
This depends on the medical reason for the tube. Some children can eat small amounts by mouth while supplementing with tube feeding. Always follow the healthcare provider's specific instructions.
Can my child go to school with an NG tube?
Yes, many children attend school with NG tubes. Work with the school nurse and staff to create a care plan. Ensure staff are trained in basic tube care and emergency procedures.
How do I know if the tube is in the correct position?
Check the external marking on the tube daily. Before each feeding, aspirate stomach contents and check pH. If uncertain, contact your healthcare provider. Never feed through the tube if placement is questionable.
What if the tube gets clogged?
Try flushing with warm water using gentle pressure. For medication residue, a small amount of carbonated beverage may help (ask your healthcare provider first). Never use excessive force. If blockage persists, contact your healthcare team.
Can my child bathe or swim with an NG tube?
Bathing is safe - keep the tube secured and avoid submerging the face. Swimming is generally not recommended due to risk of water entering the tube and infection concerns. Consult your healthcare provider for specific guidance.
What should I do if my child pulls out the tube?
Stay calm. Do not attempt to reinsert it yourself unless specifically trained. Contact your healthcare provider or go to the emergency department. The child can usually wait a few hours for professional replacement.
Are there alternatives to NG tubes?
Yes, alternatives include nasojejunal tubes (NJ tubes), gastrostomy tubes (G-tubes), and gastrojejunal tubes (GJ-tubes). The choice depends on the child's medical needs, expected duration of use, and other factors.
Will the NG tube affect my child's development or speech?
Short-term NG tube use typically does not affect development. For long-term use, work with speech therapists and occupational therapists to maintain oral skills and normal development milestones.
Storage and Equipment Care
Storing Supplies
- Keep NG tubes in original packaging until use
- Store in a cool, dry place away from direct sunlight
- Check expiration dates before use
- Keep feeding formula refrigerated according to package instructions
- Store syringes, tape, and other supplies in a clean, organized container
Cleaning Reusable Equipment
- Wash syringes and feeding bags with warm soapy water after each use
- Rinse thoroughly and air dry on clean towel
- Replace feeding bags every 24 hours
- Replace syringes weekly or if damaged
- Never share equipment between children
Traveling with NG Tube
- Carry extra tubes, syringes, and supplies
- Bring a copy of medical orders and care instructions
- Pack formula and feeding supplies in appropriate containers
- Know location of nearby hospitals or medical facilities
- Keep emergency contact information accessible
Important Considerations
Psychosocial Support
Having an NG tube can be emotionally challenging for children and families. Consider the following:
- Encourage normal activities as much as possible
- Connect with support groups for families with tube-fed children
- Address body image concerns, especially in older children and teenagers
- Maintain regular routines and family mealtimes
- Seek counseling if the child shows signs of anxiety or depression
Nutrition Monitoring
- Keep a feeding log with times, amounts, and any issues
- Monitor weight regularly as directed by healthcare provider
- Watch for signs of adequate hydration
- Report any changes in tolerance to feeding
- Attend all follow-up appointments with dietitian and medical team
Special Considerations by Region
While NG tube care is similar worldwide, some regional differences exist:
- Tube Sizes: Some countries use different sizing systems. Confirm the correct size with local healthcare providers
- Formula Availability: Feeding formulas vary by country. Use locally available, appropriate formulas as prescribed
- Healthcare Access: In areas with limited healthcare access, ensure thorough training and have clear emergency protocols
Reference Resources
For additional information, consult these trusted sources:
- Official pediatric nursing textbooks such as Wong's Nursing Care of Infants and Children
- World Health Organization (WHO) guidelines on pediatric nutrition and medical devices
- American Academy of Pediatrics (AAP) publications
- Royal College of Nursing guidelines (for UK-based information)
- Local pediatric hospital educational materials
- National health service websites in your country
Medical Disclaimer
This information is provided for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, pediatrician, or other qualified healthcare provider with any questions regarding your child's medical condition or treatment. Never disregard professional medical advice or delay seeking it because of information you have read on this website.
NG tube insertion and management should only be performed by trained healthcare professionals or caregivers who have received proper instruction and supervision from qualified medical personnel. Individual circumstances vary, and treatment plans should be tailored to each child's specific needs under medical supervision.
In case of emergency, call your local emergency number immediately.
Labels: GIT-System, Therapeutic-Devices