Feeding Your Child - Feeding Tube Workbook :: Nationwide Children's Hospital

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Feeding Your Child

Preparing the Feeding

Make sure you check the expiration or “best before” date on the container of formula. Mark the date on powdered formula when opened. Throw it away if it is not used within 30 days of opening. Be sure to wash your hands before making formula for your child. 

Liquid Formula Powdered Formula

Expressed Breastmilk

(EBM)

  • Store unopened containers of liquid formula at room temperature.
  • Cover and store open containers in the refrigerator. Use within 48 hours.
  • Warm the formula by putting the container or bottle in a bowl of warm water. Do not use hot water or a microwave oven.
  • Prepare formula following instructions given by the dietitian or the physician.
  • Warm the formula by putting the container or bottle in a bowl of warm water. Do not use hot water or a microwave oven. 
  • You can give your child fresh or thawed EBM through a feeding tube.
  • Use fresh EBM within 48 hours.
  • Use thawed EBM within 24 hours.
  • Warm the EBM by putting the container or bottle in a bowl of warm water. Do not use hot water or a microwave oven.

Important information about water used to prepare the formula:

  • Do NOT use well water.
  • You should boil your city water.
    • Boil for 1 minute with the lid on the pan. Cool before using.
    • It is recommended to boil water for the first 3 months of life (past baby’s due date), unless your medical team recommends differently.
  • If your house was built before 1986 (although the risk is low), lead could be in the water system. Run cold water for 1-2 minutes before using it to prepare formula.
  • Distilled or purified water can be used without boiling first. (All other bottled water should be boiled.)

Feeding Your Child

Feeding Methods
There are several ways to feed your child using the feeding tube. You and your child’s health team will decide which method is best for your child. You may change methods as your child’s needs change.

  • By gravity: Formula flows down from a large syringe or feeding bag through the feeding tube. You control the flow of the formula by the location of the large syringe or the roller clamp on the feeding bag tube. This method is called bolus or gavage feeding.
  • By pump: A pump controls the flow of formula from the feeding bag through the feeding tube. The pump moves the formula down the tube and into the stomach/intestine at a set rate.

If your child is very young, he or she can suck on a pacifier during feedings. This helps your baby relate sucking with the pleasant feeling after a feeding. Hold and talk to your baby while feeding.

Getting ready to feed your child

  1. Wash your hands.
  2. Measure the formula in a bottle or measuring cup.
  3. If formula is in the refrigerator, take it out and allow it to sit at room temperature for 30 minutes. Or warm the formula by putting the container or bottle in a bowl or cup of warm water.
  4. Pour a drop of the formula on the inside of your wrist to test the temperature. Be sure it is only warm and not hot – never warm formula in the microwave.
  5. When you hold your infant during feedings, keep his head raised. You may place your child in an infant seat, but only if the child’s head is raised and the child does not slump forward. If your child is older, place him in a chair or bed with the head of the bed raised 6 to 8 inches. To prevent choking, do not feed an infant or older child when he or she is lying down.

Feeding your child by gravity with a syringe (bolus)
Supplies you’ll need:

  • Formula at room temperature
  • 60 ml syringe or a catheter-tip syringe for flushing
  • Warm water for flushing
  1. Flush before the feeding
    a. Remove the plunger from the syringe.
    b. If the feeding tube does not have a clamp, pinch the tube, open the plug and insert the end of the syringe into the feeding tube (see Picture 1). If it has a clamp, open it after you insert the syringe (see Picture 2).

    Picture 1: Preparing to flush the gastrostomy feeding tube without a clamp by pinching the tube prior to flushing

    Picture 2: Preparing to flush the low profile feeding tube with a clamp

    c. Hold the syringe upright. Slowly pour the warm water into the syringe. (If you don’t know how much water to use, ask the doctor who handles problems with your child’s feeding.)
    d. Raise the syringe above the child’s stomach but no higher than the child’s shoulders. As you pour, the water runs into your child’s stomach and flushes the tube (see Picture 3 or 4 below).

    Picture 3: Flushing the gastrostomy feeding tube

    Picture 4: Flushing the low profile feeding tube

    e. Lower the syringe to the level where the feeding tube goes into the child’s stomach. This stops the water.
  2. Give the formula
    a. SLOWLY pour some of the formula into the syringe. As you raise the syringe above the child’s stomach, the formula runs into your child’s stomach (see Picture 5 or 6 below).

    Picture 5: Pouring formula into the syringe for a gastrostomy feeding tube

    Picture 6: Pouring formula into the syringe for a low profile (MIC-KEY) feeding tube

    b. Keep SLOWLY pouring formula into the syringe until you have given the required amount of formula.
    c. Lower the syringe to the level where the feeding tube goes into the child’s stomach to stop the formula and prevent the syringe from emptying.
  3. Flush after the feeding
    a. SLOWLY pour the warm water into the syringe to flush the tube (see Picture 7 or 8 below). If you don’t know how much water to use, ask the doctor who handles problems with your child’s feeding.

    Picture 7: Flushing the gastrostomy feeding tube

    Picture 8: Flushing the low profile feeding tube

    b. Clamp or pinch the feeding tube. Remove the syringe.
    c. Close the feeding tube plug.
  4. When the feeding is finished, keep your child’s head higher than his or her stomach for about an hour.
  5. Wash and store equipment. Learn more about equipment care.

Feeding your child by gravity with a feeding bag
Supplies you’ll need:

  • Formula at room temperature
  • Feeding bag
  • 60 ml syringe or a catheter-tip syringe for flushing
  • Warm water for flushing
  • IV pole or hook to hang feeding bag
  1. Check the feeding tube and prepare the feeding equipment
    a. If the feeding tube does not have a securing device, check the position of the tube.
    b. Close the roller clamp on the extension tube by rolling it to the bottom until it feels tight.
    c. Wipe the top of the formula container with a clean cloth. Shake to mix the formula.
    d. Open the formula and pour the needed amount for one feeding into the feeding bag. If your child is on continuous feedings, follow the feeding plan given by your child's medical team
    e. Hang the feeding bag on the IV pole or hook. It must be higher than your child’s head.
    f. Hold the tip of the feeding bag tubing over a container. Open the roller clamp. Do not fill the drip chamber more than half full. Let the formula run to the end of the tube, and then close the roller clamp. This pushes the air out of the tube so that it does not go into your child’s stomach.
  2. Flush before the feeding
    a. Pull up the warm water into the syringe to flush the feeding tube. (If you don’t know how much water to use, ask the doctor who handles problems with your child’s feeding.)
    b. If the feeding tube does not have a clamp, pinch the tube, open the plug and insert the end of the syringe into the feeding tube. If it has a clamp, open it after you insert the syringe.
    c. Slowly push the plunger of the syringe. Flush the water through the feeding tube.
    d. Pinch or clamp the feeding tube. Remove the syringe from the feeding tube.
  3. Give the formula
    a. Connect the tip of the feeding bag tubing to the feeding tube and unclamp the feeding tube. Open the roller clamp. This starts the flow of formula down the tube. If the feeding tube does not have a clamp, pinch the tube, open the plug and insert the tip of the feeding bag tubing to the feeding tube. If it has a clamp, open it after you insert the tip of the feeding bag tubing.
    b. After the formula has run through, clamp or pinch the feeding tube. Remove the tip of the feeding bag tube.
  4. Flush after feeding
    a. You can pour the water into the feeding bag OR flush with the syringe in the same way as before the feeding. (If you don’t know how much water to use, ask the doctor who handles problems with your child’s feeding.)
    b. After flushing through the feeding bag, close the roller clamp on the feeding bag tubing. Clamp or pinch the feeding tube. Remove the feeding bag tubing from the feeding tube.
    c. Close the feeding tube plug.
  5. When the feeding is finished, keep your child’s head higher than his or her stomach for about an hour.
  6. Wash and store equipment. Learn more about equipment care.

Feeding your child by pump
A pump delivers a continuous amount of formula at a set rate. Check your pump manual on how to feed your child with the pump. If you have any questions, refer to the manual or call the home care company that provides your feeding supplies.

Supplies you’ll need:

  • Formula at room temperature
  • Feeding set (feeding bag and extension tube)
  • 60 ml syringe or a catheter-tip syringe for flushing
  • Feeding pump and IV pole
  • Warm water for flushing

Not all feeding pumps need to be hung on an IV pole. This example shows a feeding pump in a bookbag.

  1. Check the feeding tube and prepare the feeding equipment
    a. If the feeding tube does not have a securing device, check the position of the tube.
    b. Wipe the top of the formula container with a clean cloth. Shake to mix the formula.
    c. Open the formula and pour into the feeding bag. Do not pour more than a 4 hour supply into the bag at one time, unless the dietitian has given you other instructions.
    d. Follow your home care company’s instructions on how to remove the air from the feeding bag tubing.
  2. Flush before the feeding
    a. Pull up the warm water into the syringe to flush the feeding tube. (If you don’t know how much water to use, ask the doctor who handles problems with your child’s feeding.)
    b. If the feeding tube does not have a clamp, pinch the tube, open the plug and insert the end of the syringe into the feeding tube (see Picture 9). If it has a clamp, open it after you insert the syringe (see Picture 10).

    Picture 9: Preparing to flush the gastrostomy feeding tube without a clamp by pinching the tube prior to flushing

    Picture 10; Preparing to flush the low profile feeding tube with a clamp.

    c. Slowly push the plunger of the syringe. Flush the water through the feeding tube (see Picture 11 or 12 below).

    Picture 11: Flushing the gastrostomy feeding tube using a syringe

    Picture 12: Flushing the low profile (MIC-KEY) feeding tube using a syringe

    d. Pinch or clamp the feeding tube before removing the syringe from the feeding tube.
  3. Give the formula
    The steps below apply to an Enteralite pump. If you have a different type of pump, please follow guidelines from your child’s home health agency.

    Example of a feeding bag tube connected to a feeding tube

    a. Connect the tip of the feeding bag tube to the feeding tube.
    b. Press the power ON/OFF button.
    c. Confirm the correct RATE on the pump and set DOSE to “INF.”
    d. Press the RUN/PAUSE button to start or pause the feeding.
    e. When feeding is complete, the pump will stop, beep and read “NO FOOD” to alert you that the bag is empty. Press the RUN/PAUSE button to pause and then the power ON/OFF button to turn the pump off.
  4. Flush after the feeding
    a. Pull up the warm water into the syringe to flush the feeding tube. (If you don’t know how much water to use, ask the doctor who handles problems with your child’s feeding.)
    b. If the feeding tube does not have a clamp, pinch the tube, open the plug and insert the end of the syringe into the feeding tube (see Picture 13). If it has a clamp, open it after you insert the syringe (see Picture 14).

    Picture 13: Preparing to flush the gastrostomy feeding tube without a clamp by pinching the tube prior to flushing.

    Picture 14: Preparing to flush the low profile feeding tube with a clamp.


    c. Slowly push the plunger of the syringe. Flush the water through the feeding tube (See Picture 15 or 16 below).

    Picture 15: Flushing the gastrostomy feeding tube using a syringe

    Picture 16: Flushing the low profile feeding tube using a syringe


    d. Pinch or clamp the feeding tube before removing the syringe from the feeding tube. Close the feeding tube plug.
  5. When the feeding is finished, keep your child’s head higher than his or her stomach for about an hour.
  6. Wash and store equipment. Learn more about equipment care.
  7. Keep the pump plugged in when you are not using it. This keeps the battery fully charged.

View and print the Feeding Tube Workbook

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