Going home with your baby with an NG tube

By collaborating with Kinderthuiszorg, Beatrix Birth and Child Centre can allow parents to take their premature baby home earlier than usual. Thanks to this support, you can give your baby tube feeds at home. This leaflet is full of information about tube feeding your child.

You have talked about giving your baby tube feeds at home with your paediatrician. As a result, you can go home with your baby and give them tube feeds yourself. After all, your baby

• is medically stable;
• can regulate their own temperature (with a hot water bottle if needed);
• is growing well
• is learning how to drink.

You do not have to wait for your child to learn to drink independently, because you will be giving tube feeds at home. 

Only when you are entirely ready to take over caring for your child can you go home with your baby.

At home, your child can learn to drink formula or breast milk at their own pace. Until they can do so, you can give them tube feeds at home. It is important that at least two people in your household can give tube feeds. The paediatric nurse will teach you how to tube-feed your baby at home. You also need to take an e-learning, a kind of online course.

If your baby has pulled out their tube, you do not have to insert a new one yourself. Kinderthuiszorg will do this for you. Kinderthuiszorg will provide support at home. You can reach them by phone 24 hours a day on 088-0200700.

Why does your baby need tube feeds?

There are several reasons why your baby may need to be tube-fed:

• drinking takes too much energy;
• your baby’s muscles are not yet strong enough for them to drink properly;
• your baby’s drinking behaviour is still premature, which means they cannot properly coordinate sucking, swallowing and breathing. As a result, they will not be able to drink from a bottle or breastfeed yet.

If your baby has one of these problems, they may not be able to get all the nutrients they need by breast or bottle. In that case, they need tube feeds. This is done through a thin, flexible tube called a nasogastric tube, or NG tube. An NG tube enters through the nose and passes through the oesophagus into the stomach. There is a lid on the visible end of the tube that can be used to close the tube or attach a syringe or extension tube. Your baby has an NG tube to make sure they can feed completely.

Types of tube feeds

The doctor and/or dietician will discuss with your how your baby will be tube-fed. They will go over the following:

• the type of feed;
• the amount of feed;
• the tube feed schedule;
• how to give tube feeds.

All the above depends on your baby’s age, weight and illness.

Tube feeds, breast milk and formula

The doctor, nurse and/or lactation consultant will give you information on combining formula, breast milk and tube feeding before you go home.

The speech therapist can also explain and advise on how to encourage your baby to drink.

How to give tube feeds

There are two ways to give tube feeds with a nasogastric tube (NG tube):

1. By hand: You can give tube feeds by hand, using a syringe. We’ll teach you to give tube feeds this way.
2. With a pump: This leaflet does not explain how to give tube feeds with a pump.

E-learning for parents

Before you are allowed to give tube feeds to your baby yourself, you must complete an e-learning with theory and questions. The e-learning ‘NG tube care and administering liquid feed and medication' for parents can be found on this website: https://integralekindzorgmetmks.nl/ouder-kind-educatie/ouders/. You only need to complete the section on ‘Tube feeding’.

You will receive a certificate if you pass the e-learning as proof. It is important that both parents or guardians do this e-learning and get the certificate.

Bring your certificate to your baby’s unit and show the certificate to the nurse caring for your baby. They will scan the certificate and add it to your baby’s medical record.

What do you need?

• The correct amount of feed. The feed should be at room temperature;
• A large 60ml syringe for tube feeding;
• A syringe with 2 to 3 ml of lukewarm tap water;
• Strap/tape for the tube feeding syringe.

Instructions

1. Preparation

• Before you start giving a tube feed, make sure that everything you need is within reach and in a clean place.
• Wash your hands with water and soap and dry them thoroughly or use hand sanitiser.

2. Always check the tube before feeding

• Is the tube deep enough?
• Is the tube firmly in place?
• Is the tube free of any coils and twists? (Look inside your baby’s mouth and throat).

If the answer to one of these questions is no, or if your baby pulled on the tube or vomited, check whether the tube is still in the right position. To do so, you have to measure the pH
and check the colour of the gastric fluid. Read more about pH and gastric fluid here.

Information on your baby's pH and gastric fluid

When to check the pH level

• if your baby is stuffy;
• if your baby turns blue;
• if your baby starts coughing;
• if your baby is in pain;
• if you notice that your baby is very ill;
• if your baby starts sweating heavily;

Always check the colour of the gastric fluid. If the fluid is not the right colour, contact Kinderthuiszorg. Continue reading for more information about pH and gastric fluid.

What is pH?
pH is a measure of the acidity of a solution. Gastric fluid is acidic. Measuring how acidic it is tells you whether the tube is in the right place in the stomach or not. If the pH is below 5.5, the tube is in the right place. Antacids will not affect your baby’s pH.

How to check pH

• Using an empty 10 ml syringe, draw back 2 to 5 ml of air;
• Attach the syringe to the tube;
• Inject air into the tube;
• Draw back a small amount of fluid;
• Remove the syringe from the tube and put the lid on the tube;
• Drip the fluid onto the pH strip and wait a few seconds;
• If the pH is below 5.5, The tube is most likely in the stomach.
• If the pH is above 5.5, the tube is probably not in the stomach. When this happens, do not give a tube feed and call Kinderthuiszorg on 088-0200700.

Check the colour of the gastric fluid
The tube is in the right place in your baby’s stomach if:

• The fluid is clear or cloudy;
• There are half-digested ‘strings’ of feed in the fluid;
• The fluid is colourless;
• The fluid is white or milky white;
• The fluid is off-white;
• Or the fluid is light brown.

What to do if you cannot draw back gastric fluid

• Change your baby's position. Consider putting them on their side or propping them up;
• Wait 15 to 30 minutes;
• Try drawing back gastric fluid again.
• If you still cannot draw back any gastric fluid, call Kinderthuiszorg on 088-0200700.

3. Giving tube feeds

• Wash your hands with water and soap and dry them thoroughly, or use hand sanitiser.
• Prepare the feed (along with any supplements).
• Take a large, empty 60 ml syringe and remove the plunger.
• Open the lid on the tube.
• Attach the syringe to the tube.
• Always hold the syringe above the tube. Fill the syringe with feed.
• Holding the syringe, slowly pour the feed into the syringe. The feed will go down on its own. If the feed does not go down on its own, briefly insert the plunger and push down a little before removing the plunger again.
• Hang the syringe from the strap, making sure it does not wobble and stays directly above your baby.

4. After feeding

• Remove the large, empty syringe from the tube.
• Fill a small syringe with 2 to 3 ml of lukewarm tap water and attach it to the tube.
• Slowly flush the tube with 2 to 3 ml of lukewarm tap water, making sure to flush out any remaining feed.
• Remove the empty syringe from the tube.
• Close the lid on the tube.
• Tidy everything up.
• Clean the syringes with warm water.
• Place the plunger and barrel side by side on a clean cloth and leave to dry.
• Wash your hands with soap and water and dry your hands thoroughly or use hand sanitiser.

Securing your baby’s tube

It is important to tape the tube in place so that it cannot shift. If you find that the tape is dirty or starting to detach, apply new tape. Secure the tube by taping it to your baby’s cheek.

Method:

1. Cut the adhesive tape to size;
2. Wash your hands;
3. Carefully remove the old tape (using water or tape remover) from cheek to nose, holding the tube in place with your finger. If the skin protection patch is still firmly attached, you can leave it.
4. If necessary, apply a skin protection patch first.
5. Stick the tube back onto the skin protection patch;
6. Always check that the tube is still in place after bathing and/or showering.

Tube feeding and hygiene

• Feed can only be reheated once, so always throw away any leftover food.
• You can use the syringes multiple times, making sure to wash them thoroughly with warm water and replacing them after 72 hours.
• This leaflet contains information about storing breast milk: 'Pumping breast milk'.
• Feeding tubes can remain in place for up to 6 weeks. After 6 weeks, the risk of blockage increases significantly. On top of that, leaving a tube in place for more than 6 weeks is unhygienic.

Oral care and your baby

Oral hygiene is very important for babies who need tube feeds in order to prevent inflammation and infection. Babies who do not eat or drink by themselves will start producing less saliva. This can result in cavities, as well as inflamed gums, oral mucosa and salivary glands. Your baby may also get an fungal infection of the mouth such as thrush. It is very common in babies and looks like a white coating on your child’s tongue, palate and the inside of their cheek. If you suspect that your baby may have thrush, you can easily check with a cotton bud. If the white layer can easily be rubbed off with the bud, your baby does not have thrush. Always call your General Practitioner if you suspect that your baby may have thrush or if you have doubts.

Always clean your baby’s mouth at least twice a day. Here is how:

• Gently clean your baby's mouth with a gauze pad and water.
• If your baby is teething or already has a tooth, you can start brushing their teeth. Always follow your speech therapist's advice if they advise you otherwise.

Nasal care and your baby

Because your baby has an NG tube in one of their nostrils, they need extra nasal care. Here is how to clean your baby’s nostrils.

• Clean your baby’s nose with water and dry it thoroughly.
• Gently lubricate the nostrils with a little Vaseline if needed. Avoid Vaseline if your baby is also on home oxygen therapy.
• Regularly clean your baby’s nostrils with a cotton bud and water. You can also rinse their nostrils with a saline solution if needed.
• You can prevent irritation by avoiding the side of the nose when taping the tube in place.

This chapter goes over several problems that you may experience at home, as well as how to solve them. If you can’t find your problem or aren’t sure, call the Kinderthuiszorg nurse for advice. If you have a question for a paediatrician, dietician or speech therapist, you can call them during office hours. 

Your baby is choking

Your baby may choke if feed enters their airways. If your child has any of the following symptoms, call your General Practitioner or 112 in the event of an emergency.

Symptoms to watch out for:

• Coughing
• Breathing problems, such as shortness of breath, rapid and/or audible breathing

Feed will not pass through the tube

Your baby is vomiting and/or has diarrhoea
Does your baby have abdominal cramps, nausea, or bloating? If your baby has a bloated abdomen, you can try removing some air with a 10 ml syringe.

Important: giving tube feeds and affect the quantity and texture of your child’s poo.  It may, for example, become more watery and/or slimier.

Your baby is constipated (difficulty pooing)
If your baby has not had a poo for more than three days, they are constipated (bowel obstruction). Children who need tube feeds may poo less. Note: If you are tube-feeding your child with breast milk, it is entirely normal for them not to poo for three days.

Your baby has nasal irritation and/or an irritated nostril

Great news, you can bring your baby home! While it’s something to look forward to, it can also be a nervy time. We’ll notify Kinderthuiszorg that you are going home. They will visit you on the children’s ward to explain what Kinderthuiszorg can do for you. Kinderthuiszorg and your dietician and speech therapist (as needed) will help you and support you so that you can comfortable transition from hospital to your home.

Kinderthuiszorg will also pay home visits, starting from the first week after you are discharged from hospital. Kinderthuiszorg can help you give tube feeds to your child. They can also answer any questions you may have about giving tube feeds. If your question can best be answered by a dietician or speech therapist, Kinderthuiszorg will refer you to a capable professional. You can also get support from your speech therapist, either over the phone or in the hospital.

You can call Kinderthuiszorg 24/7. You can always ask Kinderthuiszorg to insert a new tube or help you give your baby a tube feed at home.

Premature or underweight babies often have some catching up to do and may not develop the same way as other infants. With extra assistance, guidance and know-how, parents or guardians can help their baby develop optimally.

The aftercare centre is a one-stop shop for all this knowledge and support, provided by a closely coordinated team of healthcare professionals. Follow-up appointments with the paediatrician, physiotherapist, speech therapist and paediatric nurse all take place at the aftercare centre.

When you are discharged from the hospital, your paediatrician will tell you whether you have to pass on your baby’s weight to the paediatric nurse at the aftercare centre. Click here for more information about the aftercare centre.

Have any questions and/or comments after reading this leaflet? Feel free to ask the ward nurse!

• For general questions about your baby within 72 hours of your discharge from hospital, call the Beatrix Birth and Child Centre on 0183 64 44 65.
• Have a question about giving tube feeds? Call Kinderthuiszorg on 088 02 00 700.
• To order additional tube feeding supplies or ask a question, call our supplier Eurocept on 030 66 92 112 or send an email to medischevoeding@eurocept.nl.
• For general questions about your baby's development or childcare, contact the paediatric nurse at the child health centre or aftercare centre by calling 06 206 851 56 (Charlotte Huisman) or 06 836 445 66 (Soraya Oulad Saddik) or sending an email to jgz-nazorg-gorinchem@jongjgz.nl.