An NG tube is placed in the nose or mouth and passed into the stomach to feed babies and children who cannot eat enough by mouth. The document provides instructions on preparing, placing, securing, checking placement of, and feeding/cleaning an NG tube. It describes marking the tube to measure insertion depth and lubricating the tip before slow insertion. Placement must be checked before each feeding by withdrawing stomach contents or looking for signs of distress. The feeding is given slowly over 15-20 minutes and the tube is cleaned after use.

2. INTRODUCTION
Nasogastric (NG) tubes are used to feed babies and
children who cannot take in enough calories by
mouth.
The NG tube is placed in the nose or mouth and
passed into the stomach.
The EBM / formula is put into the tube and flows to
the stomach.

3. •Feeding tube
•Scissors
•50 mL syringe
•EBM / prescribed formula / Medication
•Tape or Tegaderm®
•Water soluble lubricant like xylocaine Jelly

4. PREPARING TO PLACE THE
TUBE
Wash your hands.
Cut a piece of tape, DuoDERM, or Tegaderm that is long enough to secure
the tube from your child’s nose. Put the tape on their cheek.
This will help protect your child’s skin under the tube.
Take the tube from the tip of the nose (A) to the earlobe (B), then to the
middle of the belly (C), which is halfway between the bottom of the
breastbone and the belly button. Mark the tube at point C with a marker or
piece of tape. This will let you know how far to insert the tube to reach the
stomach.

5. Children should be placed in a sitting position. Place babies on
their backs. You may need to wrap your baby in a blanket so
they don’t grab the tube.

6. PLACING THE TUBE
•Put a small amount of water-soluble lubricant on the tip of the tube. Never
use Vaseline® or any other oil-based substance.
•Put the tube slowly into the nose while aiming toward the ear. Using gentle
pressure, keep putting the tube in until the mark you made on the tube
reaches the nose.
•If the tube does not go in easily, remove it. Never force the tube. Change
your child’s position, lubricate the tip of the tube, and try again.
•Encourage your older child to swallow the tube. The tube may go into place
easier for a baby if they suck on a pacifier.

7. Put the tube on the tape, DuoDERM, or Tegaderm on your child’s cheek. Then, secure
the tube with another piece of tape.

8. HOW TO CHECK THE
PLACEMENT OF THE TUBE
Check to make sure the tube is in the stomach each time before a feeding.
To check the placement of an NG tube:
•Look at your child after the tube has been placed and they have calmed
down. If they are gagging, coughing, or turning blue, it may not be in the
right spot. Remove it.
•If you’re still worried about placement, insert a syringe into the end of the
tube and pull back gently. If you get stomach contents in the syringe, the tube
is in the correct position.
•Make sure the mark on the tube is still at your child’s nose. If it’s not, the tube
should be re-inserted to the correct position. Check again to make sure your
child is not gagging or coughing after the tube is in place.

9. FEEDING
You can feed your child after checking tube placement. The doctor or health
care provider will tell you how much formula to use for each feeding and how
often.
1.If the formula is in the refrigerator, take it out and let it sit at room
temperature for 30 minutes before feeding. You may also warm the formula
by putting the container or bottle in a bowl or cup of warm water.
1. Pour a drop of the formula on the inside of your wrist to test the temperature. Be sure it
is warm, not hot.
2. NEVER WARM FORMULA IN THE MICROWAVE.

10. 1.Hold your child while feeding. You may give your child a pacifier to suck on
during feedings. This helps your baby learn feeding skills. They will start to
connect sucking with the feeling of being full.
2.Remove the plunger from the syringe or open your feeding bag.
3.If your child is getting gravity feeds by syringe:
1. Put the tip of the syringe into the open end of the feeding tube. Hold the tip of the syringe
no higher than 10 inches above the child’s head.
1. The height of the syringe affects how fast the formula goes in.
2. Holding it higher may feed your child too fast. Your child may throw up (vomit).
2. Pinch the tube while you pour the formula into the syringe.

11. •Release the tube and let the formula enter the stomach slowly. Add more
formula as the syringe empties (Picture 3). Feed your child slowly over 15 to
20 minutes.
•If the formula does not flow, change your child’s position. If it still does not
flow, put the plunger into the syringe and gently push enough so the formula
will flow again.
•Remove the plunger.

12. •If your child starts to vomit during a feeding, stop right away. Keep their
head upright and their face turned to the right side. Wait for vomiting to stop
before feeding again.
•If they keep vomiting, take the NG tube out and call your child’s doctor

13. AFTER THE FEEDING
For syringe feeds, pour 5 to 10 mL of water into the syringe after the formula
is gone. This clears the tube to prevent clogging. This helps prevent
infection.
1.Remove the syringe and place the cap on the tube. Babies should be
burped every 2 to 3 ounces and after feedings.
2.If you put your child to bed after the feeding, put them on
their back without stuffed animals, toys, or a blanket (Picture 4). This is
the safest position for your baby.
If your child begins to vomit, turn their head to the side and open the cap to
the tube.

14. Cleaning the Equipment
1.Place a clean paper towel on an empty tray.
2.Rinse the syringe and measuring container with cold water.
3.Then, wash them in hot, soapy water.
4.Rinse and dry.
5.Place the clean items on the tray.
6.Cover with a paper towel and store out of the reach of children and pets.

15. Removing the Tube
1.Your child’s doctor may want you to remove the tube. If you need to remove it, loosen the
tape. Pinch the tube to prevent breathing in (aspirating) stomach contents.
2.To remove the tube, loosen the tape on the face. Pinch the tube to prevent your child from
breathing in stomach contents and gently remove the tube from the nostril.
3.If the NG tube needs to be replaced, a new NG tube should be inserted. If a new tube is
not available, the tube can be washed and reused (see cleaning instructions). If the NG
tube uses a guide wire, replace the guide wire in the NG tube before replacing. Remove
the guidewire upon placement.
4.Change which nostril is used each time you replace the NG tube.
5.Change the tube once a month unless it becomes clogged, dirty, or damaged.

16. WARNING
•he feeding set tubing can get wrapped around a child’s neck. This can lead
to choking (strangulation) or death.
•DO NOT leave the feeding set tubing where infants or children can get
tangled up in it.
•Talk to your child’s doctor or health care provider:
• If your child has been tangled in their tubing before.
• To learn steps you can take to help make sure the tubing does not get wrapped around
your child’s neck, such as keeping the tubing away from the child as much as possible.
• Any other concerns you may have about the risk of strangulation from feeding set
tubing.