Tube feeding - children

A guidance for parents how to place the tube and how to administer the nutrional liquid to your child. This guide is a supplement to the verbal information given from the nurses.

A guidance for parents

This written guidance is a supplement to the guidance and training you will receive from the nurse or the dietitian before you will give your child tube feeding on your own.

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Why tube feeding?

It is important that your child gets adequate nutrition. It is a good idea to introduce tube feeding, if your child is unable to feed himself.

Tube feed is a nutritionally complete product and corresponds to your child receives a meal incl. vitamins and minerals. Each child has his own needs, which depends on age, gender and physical activity. We calculate your child’s daily energy need. Such calculation is always an estimate, and therefore we may have to adjust the amount later on.

Before you begin with tube feeding

It is important to keep a good hygiene. Bacteria thrive and multiply in the tube feed products. Wash therefore hands thoroughly before you begin.

The tube feed should be at room temperature because very cold tube feed can cause stomach pain.

If your child still is able to eat or drink a little bit, it is very important to continue to offer your child as much food and drink, as she/he can take. Make sure that your child is still a part of the family meals and that your child gets a small amount of food on his plate, even if it might only be a few bites. It is important that the child experience the social part of a family gathering even though the meal is not eaten by the child.

For the baby that receives tube feed, it is also important to maintain the sucking reflexes by offering the baby a bottle. When the baby receives tube feed, let him/her suck the pacifier. Sucking movements stimulates saliva production and helps with digestion. If the baby has not received food through the mouth for an extended period of time, it can be difficult for the child to start to eat / drink again. It’s a good idea to stimulate the mouth with a pacifier.

Administration

Tube feeding can be given in 3 different ways: in portions like meals (bolus), continuous or continuous for periods, interrupted by small breaks. We choose the type of administration that fits your child the best.

Before starting tube feeding you should control the tube placement is correct and it is not plugged by flushing with enough water to clear the tube (2-5 ml of water, depends on the size of the child). This should also be done after giving tube feed. To reduce the risk of food entering the lungs when feed, it is recommended that the child sits up and at least half an hour after the meal. Alternatively, raise the bed to an angle of 30-45 degrees, or lay down the child down on its right side. Children who can only lie on their back and weakened children with impaired cough and / or swallowing reflex should be observed while giving tube feed.

Portions (Bolus)

The tube feed is given as portions that corresponds to the meals the child usually eat, approx. 5-6 meals. If your child has a difficulty handling the amount in every portion, it can be increased to 7-8 smaller portions.

Continuous with breaks

The tube feed is giving by a feeding pump over a certain number of hours. Breaks are given so the child is not linked to tube feeding all the time. Ex. Tube feeding can be given only at night, so the child has appetite to eat during the day, or it can be given only a few hours during the night and day.

Continuous

Some children are very sensitive and cannot tolerate large portions. Therefore tube feed is given very slowly over 24 hours by a feeding pump. This can reduce nausea and vomiting.

Feeding pump

If your child needs a slow continuously supply, the feed will be given by a portable feeding pump. You will receive instructions in how to use the pump before discharge.

Nausea

It is important that your child is not feeling nauseous when receiving the tube feed. An effective nausea treatment is important and it may be necessary to prevent nausea by offering fixed-nausea treatment over a longer period of time.

Diarrhea

If your child experiences diarrhea, it may be necessary to switch to another product. This should be discussed with the clinical dietitian or the doctor. Some children may benefit from addition of lactic acid bacteria to their feed. This is an option when the diarrhea is caused by antibiotic treatment.

Durability/shelf life during administration

If the tube feed is coupled to a feeding set in a closed system, the shelf life is 24 hours. The feeding set should be changed when changing the tube feeding bag.

If the child is feed in portions, the tube feeding bag should be store covered in the refrigerator for 24 hours after opening. Powder mixtures mixed by you is not a sterile product and therefore it should only hang for 4 hours. Remember to change the feeding/connecting set as well after 4 hours.

Storage of tube feed products

After the company has delivered the tube feed products it should be stored cool and no more than 25 Celsius degrees. The tube feed products should not be exposed to direct sunlight. Tube feeding in glass bottles should give a “click” sound when opening it. Pay attention to the expiration date when you receive the products.

Control of tube placement

To ensure that the tube is placed correctly in the stomach, do the following: Check the mark on the tube is where it is suppose to be and that it has not slipped further up or down. Next, using a 10-20 ml syringe, gently withdraw fluid from the stomach. This procedure is called aspiration from the tube. If you cannot withdraw any fluid from the stomach, try to push 5-10 ml air into the tube, this will help obtain some stomach fluid.

Thereafter you should assess the liquid from the stomach. It should look like stomach fluid, preferably with a mix of tube feed. If you are in doubt, you can check the acidity with a pH stix. pH must be <6 unless if the child is given proton pump inhibitors such as Losec. 

The tube’s placement must be checked before each feeding if portions are given. For continuous feeding, the tube placement must be checked 3 times a day. The tube placement should also be controlled if your child starts to cough, vomit or feel bad when tube feed is given. If you have any doubt about the tube’s placement you should contact the hospital.

Medicine

To avoid clogging of the tube is important to be aware of the following:

Medicines should not be mixed into the feeding bag. Tablets should be crushed and dissolved in 10 to 20 ml of water prior to administration. Tablets with a coating should dissolve for a longer time before the coating is completely dissolved. Some mixtures may be so viscous that it may be necessary to dilute them with some water. The tube should first be washed with 2-5 ml of water before the medication is given with a syringe. Rinse after each portion of medicine before the tube feed is given again. In children with a weakened immune system you should use sterile water.

Clogging of the tube

It can be difficult to fix a clogged tube, therefore try to use smaller syringes to flush the tube with hot water (not from the hot tap), carbonated mineral water or cola. Canned pineapple juice is also useful because it contains an enzyme which can dissolve the blockage. If possible, you can put the juice in the tube and allow it to "sit" for ½ -1 hour before flushing again.

Care and replacement of the tube

If your child throws up the tube, it will be pulled all the way up through the nose. A new tube must be placed in the hospital. If you wish, the nurse can teach you to place the tube on your child.

Every day you should check that the tube is fixed to the same point. The tube can slide up or down. Change the patch when needed.

Clean your child’s nostrils every day, so your child can breathe better through the nose. Check the skin beneath the patch and make sure that the skin is not irritated. The patch can be moved to intact skin, as needed. The tube can also be fixed on the nose. Observe the nostril for pressure marks and move the tube to the other nostril when needed.

It is important to maintain good oral hygiene to prevent fungus and ulcers in the mouth and throat because it can occur with prolonged tube feeding.

Orders

You can read in the chart what type of tube feeding product and accessories your child is using. These items will be delivered to your home. In the future, you are responsible for ordering the products (see telephone numbers in the chart)

The products can be ordered directly from the company, or you can buy it in a pharmacy. The products are on a green prescription that is valid for ½ year. If the products are delivered directly from the company, the prescription has been faxed to them. If you want the products from the pharmacy you must have the prescription with you. When the prescription expires, you can renew it by calling the clinical dietitian.

Payment

The cost of tube feeding products are covered by the health insurance with 60 % and the home municipality with 40 % when the child has a long lasting illness. When you receive your products the bill is included. You must take this bill to your home municipality. Your home municipality may also fax the payment commitments directly to the company, and the bill can then go directly to the municipality.

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