Giving Your Child Bolus Gastrostomy Feedings through a PEG or MIC-G™ Tube

1. Wash your hands.
2. Gather these items:
3. 30-60 ml syringe
4. Measuring cup
5. Small cup of water
6. Formula (at room temperature)

For pump method:

1. Feeding set
2. Feeding pump

Position your child sitting up. For an infant, use an infant seat or a mattress with the head raised. Once the feeding has begun, you may hold or cuddle your child.

Gravity method (using a syringe)

1. Tell your child what you will be doing.
2. Wash the area around the end of the g-tube. Remove the cap or plug from the g-tube.
3. Remove the plunger from a 60 ml syringe and put the syringe into the end of the g-tube. Then unclamp g-tube.
4. Hold the syringe no more than 6 inches above your child’s stomach.
5. Pour pre-measured formula into syringe.
6. Continue to pour formula into the syringe slowly as it empties.
7. Each feeding should flow in over a few minutes. Holding the syringe higher will make it flow faster. Holding it lower will make it flow more slowly.
8. When the feeding is finished, pour water into the syringe to flush the g-tube and clear it of formula. Use 5 ml of water for an infant and 10-30 ml for an older child.
9. If needed, replace the plunger into the syringe and push gently to push the remaining water into the stomach.
10. Clamp the g-tube and then remove the syringe. Put the cap into the end of the g-tube.
11. Wash the syringe with warm water and mild soap and rinse well. Let it air dry and then store in a clean area until the next feeding.

Feeding set method (using a pump)

1. Tell your child what you will be doing.
2. Remove the cap from the end of the feeding set.
3. Fill the feeding set with the prescribed amount of formula. Do not touch the inside of the set.
4. Let formula run completely through the tubing to get rid of all air. Then clamp the tubing shut with the roller clamp.
5. Place the tubing into the pump and set the pump at the proper rate.
6. Wash the area around the end of the g-tube and then remove the cap or plug from the g-tube.
7. Connect the feeding set to the g-tube and unclamp the tube.
8. Open the roller clamp on the feeding set.
9. Turn on the pump and watch to see that it starts to work.
10. When the feeding is finished, clamp the g-tube and disconnect the feeding set. Attach the syringe, then unclamp the tube and flush with water, using 5 ml for an infant and 10-30 ml for an older child.
11. Clamp the g-tube and then insert the cap or plug into the end of the g-tube.
12. Wash the feeding set with warm water and mild soap. Rinse well. Let it air dry and then store in a clean area until the next feeding.

• Wash your hands before mixing formula. Use clean bowls, measuring cups, and spoons. If you are using cans of formula, wash the top of the can before you open it.
• Always store formula in a clean container.
• When making formula from powder, make only enough for 24 hours and refrigerate. Throw away any leftover formula 24 hours after mixing it.
• Ready-to-feed formulas can be used up to 48 hours once opened. Refrigerate after opening.
• Do not use formula after the expiration date found on the side of the bottle or can.
• If the g-tube feeding is in addition to feeding by mouth, let your child to eat before giving the g-tube feeding.
• Brush your child’s teeth, gums, and tongue at least two times each day.
• Offer your infant a pacifier to suck on during feedings. This will help him/her get used to sucking while feeding. If your child is older than 1 year, talk to your child’s doctor or nurse for guidance on oral stimulations during bolus feedings.
• Hold and cuddle your child during feedings when possible.
• Stabilize the g-tube to the belly surface with tape to avoid pulling and tension at the g-tube site.
• Replace feeding sets as instructed by your home care company. You may want to write the date you change it on the calendar.
• Your doctor or nurse will arrange for a home care company to deliver the supplies you need. Call your home care company to make sure that they have your child’s appropriate prescriptions with refills.
• Please contact your home care company when you are getting low on supplies so that they may send more before you run out.
• Call your home care company if you have any trouble using the feeding pump.

• Your child has severe coughing, blueness around the lips, or trouble breathing. Stop the feedings and call an ambulance if his or her breathing or color does not get better right away.
• Your child throws up with each feeding
• Your child complains of heartburn or appears uncomfortable with feedings
• Your child has diarrhea or cramping
• You have any questions or concerns

Please call the GI office at 617-355-6058 if you have questions or concerns. Our GI nurses can help you with all types of PEG tube questions:

• From 8 a.m. to 4:30 p.m. weekdays, a nurse in the GI clinic will be available to help you.
• Weekdays after 4:30 p.m., weekends, and holidays, you can use the same number to reach a GI doctor on-call for urgent questions or emergencies.

If your child is followed by General Surgery,

• From 8:30 a.m. to 5 p.m. weekdays, call the General Surgery outpatient nurses at 617-355-7716 or 617-355-7704.
• Weekdays after 5 p.m., weekends, and holidays, call the Boston Children’s page operator at 617-355-6369 and ask for the General Surgery Senior Resident on-call.