Tube feeding with a gastrostomy tube for babies and children — Canterbury Whāngai ā-ngongo ki te ngongo ā-puku mā ngā tamariki

A gastrostomy is an artificial opening (stoma) through the tummy (abdomen) into the stomach. It lets feed, fluids and medications go directly into the stomach through a feeding tube. This page tells you how to give feed and medications to your tamariki (child).

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Gastrostomy and feeding tubes for babies and children

A gastrostomy is an artificial opening through the tummy (abdomen) and into the stomach of your tamaiti. A feeding tube is inserted through the opening. This is so special liquid food (feed), medications and fluids can go directly into their stomach or small bowel (to the jejunum, which is below the stomach).

Tube feeding

There are 2 types of gastrostomy tubes used in tamariki:

  • PEG (percutaneous endoscopic gastrostomy)
  • PEG-J (percutaneous endoscopic gastrojejunostomy).

These terms describe how the tube is fitted and where it is placed.

The MIC-KEY button is a low-profile PEG or PEG-J device. It is used with an extension set that is needed to access the feeding port.

The PEG and PEG-J tubes have a flange (bumper) inside the stomach to keep the tube in the right position. The MIC-KEY button has a small balloon filled with water to hold it in place within the stomach.

A gastrostomy PEG feeding tube and a MIC-KEY button used in a child. A, feeding port. B, flange (bumper). C, clamp. D, MIC-KEY button. E, extension set.

Caring for your child's stoma and feeding tube

The stoma

  • For the first 1 to 2 days after your tamaiti has their tube inserted, you can expect a small amount of discharge from the stoma. This will get less as it heals.
  • For the first 10 to 14 days, clean the stoma at least once a day using a saline solution.
  • After 14 days, you can clean the stoma daily with warm soapy water.
  • Always dry under the tube flange to minimise moisture against their skin.
  • For the first 10 to 14 days, you can apply an antimicrobial dressing to their stoma. A dressing is not needed long term.
  • After your tamaiti has their tube inserted, they can have a bath after 48 hours and swim after 2 weeks, or as advised by your surgeon.

The feeding tube

Important — if the feeding tube comes out, the stoma will begin to close within 2 to 3 hours. Put the tube that has come out back in the hole if you are able to. This will help to stop the hole from closing.

Contact the Children's Outreach Nursing Service immediately within normal working hours. Contact Children's Emergency Care after hours immediately (see contact details below). Your tamaiti may need to go to the hospital to have the tube put back in.

  • Starting the day after your tamaiti has their tube inserted, turn the tube 360 degrees daily. This stops the tube from sticking.
  • Attach their feeding tube to their stomach using the tube fastener supplied by the Children's Outreach Nursing Service. This will stop it moving in the stoma.
  • If your tamaiti gains or loses weight, you can reposition the flange (bumper) on the tube by sliding it up or down the feeding tube. It should always sit 1 mm to 2 mm away from the skin.
  • Before starting the feed, always check that the flange (bumper) is in the same position.
  • If you are not using the feeding tube for feeding, flush it with warm water at least twice a day.
  • Contact the Children's Outreach Nursing Service if the feeding port on the tube needs replacing.

How to feed your child using the tube

Flush the feeding tube with warm water before and after you tube feed. Also flush it before and after you put medications down their tube.

If you have safe drinking water, you can use tap water to flush the tube. Otherwise, use boiled, cooled water.

If your tamaiti has a jejunal tube, always use cooled boiled water to flush their tube.

Important — only use the tube for:

  • the feed prescribed by your dietitian or healthcare provider
  • water
  • prescribed medications.

How to give medications through your child's tube

Do not put puréed food down your child's feeding tube.

Feeding methods

There are 3 methods of tube feeding:

  • gravity feeding
  • bolus feeding
  • pump feeding.

Your dietitian will decide which type of feeding is best for your tamaiti.

Gravity feeding

This is where the feed flows out of a syringe or feed bottle and into the feeding tube by gravity.

Bolus feeding using a syringe

This is when your tamaiti has a set amount of feed at specified times during the day. This is like having meals at mealtimes.

Pump feeding

This is when a pump is used to continuously deliver a set amount of feed through the feeding tube over a set amount of time.

Your dietitian will discuss these options with you in more detail and provide you with a feeding plan and instructions when needed.

Caring for your child's equipment and feed

  • After feeding, wash the syringe with mild dishwashing detergent. Rinse it thoroughly and leave it to air dry.
  • Place the syringe in a clean zip lock bag or a clean container with a lid. Store it in the fridge to prevent it being contaminated by bacteria.
  • You can use each syringe for about 2 weeks.
  • Giving sets (only used for pump feeding) can only be used for 24 hours. Throw them away after you have used them for 24 hours and do not reuse them.
  • Cover open cans or bottles of feed and store them in the fridge. Throw away any open, unused feed after 24 hours.
  • You can use open ready-to-hang bottles of feed for 24 hours. Throw away any open unused feed after 24 hours.
  • The feed should be at room temperature when you use it. If it has been in the fridge, leave it for 30 minutes before using it.

How to give medications through your child's tube

The hospital pharmacist will review your child's medications before you go home. They will make sure your tamaiti can take the medications through their feeding tube. There are some important points to note.

  • Use the main port of the feeding tube for medications.
  • Use the bolus feeding method (see above) to put medications down the feeding tube unless your dietitian or nurse tells you to do it another way.
  • Flush the tube with 5 ml to 10 ml warm water before and after giving medications. This helps to prevent the feeding tube from blocking.
  • If your tamaiti has more than 1 medication, give them each one separately. Flush the feeding tube with 5 ml to 10 ml of warm water between each medication.
  • Finely crush each solid medication separately (a mortar and pestle is best for this). Mix it with 5 ml to 10 ml of water before putting it down the feeding tube.
  • You can put liquid medications down the feeding tube without diluting them.

Troubleshooting tube feeding problems for your child

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Possible cause

Your tamaiti may have an infection. First check that the flange is not too firm on their skin.

Recommended action

See your healthcare provider, who may prescribe antibiotics. If your tamaiti has a fever, chills and tiredness, see your healthcare provider, as soon as you can. If it is after hours, go to an after-hours clinic or emergency department.

The skin is raw around the tube insertion site. You may also notice increased fluid or discomfort around the area.

Possible cause

Your tamaiti may have what is called overgranulation tissue.

Recommended action

This is common and easily treated. Contact the Children’s Outreach Nursing Service within normal working hours. Contact details are below.

Recommended action

Try to unblock it using a 60 ml syringe half filled with warm water. Use a gentle push and pull method to clear the blockage.

If you cannot clear the blockage, contact the Children’s Outreach Nursing Service. Contact details are below.

If your tamaiti needs their tube to stay hydrated and to take essential medications, contact Children’s Emergency Care if the blockage occurs after hours. Contact details are below.

Possible cause

Your tube may have come out of their stomach but is still sitting under their skin.

Recommended action

Contact the Children’s Outreach Nursing service. If after hours, contact Children’s Emergency Care. Contact details are below.

Children's supplies, syringes and giving sets

Your dietitian and the Children’s Outreach Nursing Service will organise your first supply of syringes and giving sets. For an ongoing supply, contact Nurse Maude Supply Services (contact details below).

Give as much notice as possible. Let them know if you cannot collect the giving sets — they can courier them to you. There is no charge for giving sets or syringes, but there is a small fee for delivery.

If you live in Ashburton, phone the Ashburton Supply Department (contact details below). You will need to collect the giving sets from the supply department.

If your pēpi or tamaiti needs a prescribed feed, your paediatric dietitian will prescribe the feed and organise for it to be delivered to your home. If you need to contact your feed supplier because your feed has not arrived, use the contact details below.

Within Canterbury, contact your dietitian by email for a new prescription when you have a 10-day supply of feed left.

Contact details for child gastrostomy tube feeding

Children's Outreach Nursing Service

To contact the Children's Outreach Nursing Service:

Our hours are Monday to Friday, 8:00am to 4:30pm

For urgent help after hours, for example, if your child's tube falls out, phone Christchurch Hospital and ask to speak with Children’s Emergency Care.

Nurse Maude Supply Services

To contact Nurse Maude Supply Services:

Our hours are Monday to Friday, 8:30am to 4:30pm

Ashburton Hospital Supply Department

To contact us:

  • phone: 03 307 8462
  • address: Ashburton Hospital, Entrance D, 12 Elizabeth St, Ashburton.

Open for collection Monday to Friday, 10:30am to 2:30pm.

Feeding pump suppliers

For any issues with your pump, use the following contact details:

FreeGo pump — Abbott Nutritionexternal link

Nutricia Flocare Infinity Pump II — Nutriciaexternal link

Feed suppliers

Abbott and Nestle feed (through Unichem Ilam HealthWorks Pharmacy)

Nutricia feed