Giving Your Child Bolus Nasogastric (NG) Tube Feedings

1. Wash your hands.
2. Gather the following items:
   • 30-60 ml syringe or feeding set
   • Measuring cup
   • Small cup of water
   • Formula (at room temperature)
3. Pour the correct amount of formula into the measuring cup.
4. Fill the feeding set with formula if you are using this method. Clamp the end of the tubing. (See “Steps for Bolus Feeding, part B: Feeding set Method.”)
5. Position your child with his or her head elevated. Infants should be placed in an infant seat or on a mattress with the head raised. If necessary, wrap your child in a blanket so he or she is unable to pull the tube out. Older children should sit upright. Once the feeding has begun, you may hold or cuddle your child.
6. Always check for correct placement of the NG tube before giving a feeding. (Refer to Step #11 in ("Home Care Instructions for Inserting Nasogastric Feeding Tubes.")

Syringe method

1. Tell your child what you will be doing.
2. Remove the cap or plug from the NG tube. Be sure to fold over tubing so stomach contents are not able to leak out when uncapping.
3. Remove the plunger from a 60 ml syringe and insert the syringe into the end of the NG tube.
4. Hold the syringe set no more than six inches above your child’s head.
5. Pour pre-measured formula into syringe.
6. If necessary, push gently with the plunger to start the flow of formula. Then remove the plunger, and allow the formula to flow freely by gravity.
7. Continue to pour formula into the syringe slowly as it empties.
8. Each feeding should flow in over 20-30 minutes. Holding the syringe higher will make it flow faster. Holding it lower will make it flow more slowly.
9. Always stay with your child during feedings.
10. When the feeding is finished, pour warm water into the syringe to flush the tubing and clear it of formula. Use 10 ml for an infant and 30 ml for an older child.
11. Remove the syringe. Reinsert the cap or plug into the end of the NG tube.
12. Wash the syringe with warm water and mild soap. Rinse well. Store in a clean area until the next feeding.

Feeding set method

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 formula. Open the clamp on the feeding set and allow feeding to run completely through the tubing to get rid of the air. Then clamp the tubing shut with the roller clamp.
4. Remove the cap or plug from the NG tube.
5. Connect the set to the NG tube.
6. Secure the tube to your child’s clothing. Place a piece of tape around the end of the tube. Pin the tape to your child’s shirt or pajama top.
7. Open the clamp on the feeding set to start the flow of formula.
8. Each feeding should flow in over 20-30 minutes. Rolling up the clamp will open the tubing and make the feeding flow faster. Rolling down the clamp will pinch the tubing and make the feeding flow more slowly.
9. Always stay with your child during feedings.
10. When the feeding is finished, remove feeding set from NG tube and flush tube with warm water. Use a 10 ml syringe for an infant and 30 ml syringe for older child.
11. Reinsert the cap or plug into the end of the NG tube.
12. Wash the feeding set with warm water and mild soap, and rinse well. Store in a clean area until the next feeding.

• Stop the feeding immediately if your child has severe coughing, blueness around lips, or difficulty breathing. Call an ambulance if his or her breathing or color does not improve right away.
• Wash your hands when preparing formula. Use clean bowls, measuring cups, and spoons. If using cans of ready-to-feed formula, clean the top of the can before opening.
• Clean any visible debris from the end of NG tube prior to opening cap.
• Always store formula in a clean container.
• When making formula from powder, make only enough for 24 hours and refrigerate. Discard any remaining 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 unopened formula after the expiration date found on the side of the bottle or can.
• Warm only enough formula for one feeding.
• Brush your child’s teeth, gums, and tongue at least two times each day.
• Give your infant a pacifier to suck on during feedings, if he or she will take it. This is especially important for bolus feedings. If your child is older than 1, you may want to speak to your child’s doctor or nurse for guidance on oral stimulation.
• Hold and cuddle your child during feedings whenever possible.
• Your child’s nurse will arrange for a home care company to deliver the supplies you need. Call your home care company before you need more supplies.

Call if your child:

• Vomits with each feeding
• Complains of heartburn or appears uncomfortable with feedings
• Has diarrhea or cramping
• If you have questions or concerns