Patient education: How to put in a child's nasogastric tube (The Basics)

What is a nasogastric tube? — A nasogastric, or "NG," tube is type of feeding tube (figure 1). It is inserted through 1 of the nostrils and guided down into the stomach through the nose.

This type of tube is for children who cannot get enough food and nutrients by mouth. A child might also get medicines through their NG tube.

NG tubes are typically replaced about once a month, or sooner if the tube falls out. The tube can be replaced at the hospital, in a doctor's office, or at home.

Is having an NG tube painful? — Once the tube is in, it should not be painful. But putting the tube in can be uncomfortable. It is normal for children to cry, gag, or want to move their head.

It is NOT normal for the child to cough, choke, or change color around their lips. If any of these things happen while you are putting the tube in, pull it out right away. If you are not sure, it is best to pull it out and try again.

How do I prepare to put in a child's NG tube? — Your child's medical team will teach you how replace the NG tube at home. Make sure that you understand exactly what you need to do. Ask questions if there is anything you do not understand.

To get ready to put the NG tube in, wash your hands and gather your supplies. You will need:

●The right size and kind of NG tube

●A small piece of tape or a permanent marker to mark the tube

●Water-based lubricant (not petroleum jelly)

●Tape or a clear dressing to hold the tube to the face after it is put in

●Cream or ointment, if you use this – Your doctor or nurse might recommend a "skin barrier" or "skin protectant." This helps keep the child's skin from getting irritated by the tape or dressing.

You will need to measure how far the tube will need to be inserted. To do this, follow these steps (figure 2):

●First, use 1 hand to hold the end of the tube to the tip of the child's nose. With the other hand, bring the tube to the bottom of their earlobe.

●Use 1 hand to keep holding the tube at the child's earlobe. Then, use the other hand to bring the tube to the point midway between their "xiphoid process" (the end of their breastbone) and their belly button.

●Mark the midway point between the breastbone and belly button on the tube with a marker or small piece of tape. This is how far the NG tube will be inserted.

To get the child ready:

●For babies or young children:

•They need to be still, so you might want to lay them on their back and wrap them snugly in a blanket with their arms at their side.

•You might want another person to help you or hold the child (figure 3).

•It might help to give the child a pacifier while the tube is being put in.

•If you will use a skin barrier or protectant cream, apply this to the child's face before beginning to put in the tube.

●For older children:

•Ask another person to hold the child on their lap, with the child's arms at their side (figure 2).

•It can help to give them some water to sip through a straw as the tube is being put in.

•If you will use a skin barrier or protectant cream, apply this to the child's face before beginning to put in the tube.

Check and prepare the NG tube:

●The tube might have a guidewire or "stylet." This is a thin wire inside the tube that makes it easier to put it in. Once the tube is in place in the child's stomach, you pull the wire out. Your child's doctor or nurse might tell you to flush the tube with a small amount of water. This makes it easier to remove the stylet once the tube is in.

●Dip 2 to 4 inches (5 to 10 cm) of the tube in water-based lubricant. This helps the tube slide in more easily. Do not use petroleum jelly (sample brand name: Vaseline) for this. Use only water-based lubricants.

●Get the tape or dressing that you will use to hold the tube in place ready.

Once you have measured and prepared the NG tube and prepared the child, you are ready to put the tube in place.

How do I put in the NG tube? — To put in the NG tube:

●Make sure that your child is still and cannot move around.

●Gently push the lubricated end of the tube in through 1 of the child's nostrils. Aim the tip of the tube toward the back of their throat.

●Continue gently pushing the tube in. If the tube seems to be getting stuck, try pulling back a little and then pushing forward again. If the tube starts to come out of the child's mouth, pull it out and try again.

●Stop pushing when the mark or piece of tape from when you measured the tube reaches the child's nostril. This is the stopping point.

●If the tube has a guidewire, hold the tube between your fingers with 1 hand. Use the other hand to gently pull the wire out.

●Tape the tube to your child's cheek to hold it in place. Make sure that the mark or small piece of tape on the tube is at the opening of the child's nose. The extra tubing can be attached to their clothing. This will help keep the child from pulling on the tube.

Once the tube has been put in, check that it is in the correct place. You should also check that the tube is in the right place before using it for feeding or giving medicines. Your doctor or nurse will tell you exactly how to do this.

What else should I know? — You need to know the exact amount and kind of liquid food or formula to feed the child. You also need to know how to give them medicines through the tube, if needed, and how to keep the tube clean.

Your doctor or nurse will tell you how to feed the child and give medicines through the tube, and how to clean it. Make sure that you understand exactly what you need to do. Ask questions if there is anything you do not understand.

When should I call the doctor? — Remove the NG tube right away if the child shows signs of not being able to breathe. These include:

●Trouble breathing

●Choking

●Skin color changes to blue or gray

●Being unable to talk or cry

If your child still has trouble breathing after you remove the tube, call for emergency help (in the US and Canada, call 9-1-1).

Call your child's doctor for advice if any of these things happen:

●The child's nose is red, swelling, bleeding, or painful.

●The NG tube is clogged, or you are not able to put in a new tube.

●The child has an upset stomach or nausea, or vomits.

●The child has swelling in their belly.

●The child has blood in their bowel movements.

More on this topic

Patient education: How to care for a nasogastric tube (The Basics)
Patient education: Enteral (tube) feeding (The Basics)
Patient education: How to give a tube feeding (The Basics)
Patient education: What to expect in the NICU (The Basics)