Infant Feeding Tube: Uses, Types, Procedure And Risks

Feeding tubes for infants serve to provide foods and medicines directly into an infant's stomach until they learn to swallow. It is a tiny plastic tube that goes through the nose or mouth into the stomach.

There are a few conditions when feeding tubes are used for infants. If the baby has swallowing problems or risk of aspiration into the airway, this form of enteral nutrition is preferred. It is used only for babies who show normal stomach and intestinal functions.

Read on to know more about the types of feeding tubes, the indications for requirement, the contraindications, risks, and duration of use.

Why Does A Newborn Need A Feeding Tube?

Newborns who cannot feed themselves from the breast or bottle require a feeding tube. Breastfeeding or bottle-feeding requires strength and coordination. The infant should be able to suck and swallow from the breast or bottle nipple. If a baby is unable to do so, a healthcare provider may recommend a feeding tube.

A feeding tube is recommended if the infant has any of the following issues (1).

  • No weight gain
  • Irregular patterns of weight gain
  • Lack or weak suckling reflex
  • Absence or weak swallowing reflex
  • Respiratory distress
  • Gastrointestinal defects
  • Electrolyte imbalance and problems

Being premature or sick may make it difficult for newborns to feed themselves. In such cases, feeding tubes are a safe and efficient way to provide nutrients and medicines to the body.

Types Of Feeding Tubes

There are various types of feeding tubes for enteral feeding. These may include (2) (3):

  • Nasogastric tube (NG) is a tube that is passed through the nose into the stomach. It is usually used to feed for two to four weeks.
  • Nasojejunal tube (NJT) is a tube that is passed through the nose to part of the small intestine called jejunum (second part). NJT tubes are recommended if the baby has problems with emptying the stomach, pancreatic surgery, or any blockage.
  • Jejunostomy tube (JEJ) is a tube that is inserted directly into the jejunum through a hole in the belly. It is usually used for babies after esophageal (food pipe) or gastric (stomach) surgeries. The tubes can be of two types — the percutaneous endoscopic jejunostomy tube (PEJ) and the radiologically inserted jejunostomy tube (RIJ). PEJ tubes are inserted under endoscopic guidance, and RIJ tubes are X-ray guided.
  • Gastrostomy tube (G-tube) is a tube that is inserted directly into the stomach through a hole in the belly. It is often used for feeding. It can be a radiologically inserted gastrostomy tube (RIG) or percutaneous endoscopic gastrostomy tube (PEG), depending on the imaging technique used.
  • Orogastric tube (OG) is a tube that is passed through the mouth and into the stomach. It is similar in purpose to a nasogastric tube. An orogastric tube could be preferred in cases where the baby has nasal problems or has other nasal intubations.

Pediatricians choose the method of feeding and type of tube based on the baby's health condition. Some may require imaging tests before tube insertion to examine the digestive system. Babies with more feeding complications are provided with parenteral nutrition, that is, the administration of nutrition into the bloodstream through a vein.

How Is A Feeding Tube Placed?

A feeding tube is placed through the nose or mouth after measuring the estimated length from the tip of the nose to the bottom of the ear lobe and from the ear lobe to a point between the sternum (breastbone) and belly button. Usually, the placement of the feeding tube is confirmed by auscultation or X-ray. Doctors may listen over the stomach after pushing some air into the tube using a syringe.

Feeding tubes may often be placed into smaller intestines for babies with severe feeding problems to provide continuous and slower feeding. Breastmilk or formula can be given to the baby using the feeding tubes.

What Are The Risks Of A Feeding Tube?

Feeding tubes are mostly safe. The insertion of feeding tube might cause some irritation or discomfort to the baby. Similarly, an incorrectly placed tube can also cause the baby to be uncomfortable. A misplaced feeding tube may increase the risk of the following problems in infants (4).

  • Bradycardia (slow heart rate)
  • Breathing issues
  • Coughing
  • Spitting up or vomiting
  • Cyanosis around the mouth
  • In rare cases, incorrect insertion may cause a puncture in the stomach

Despite correct placement, some babies may experience the following issues with feeding tubes.

  • Irritation of nose and mouth
  • Stomach irritation
  • Minor bleeding
  • Nasal infections
  • Stuffy nose

How Long Can A Baby Be On A Feeding Tube?

The feeding tube can be left for months in infants. However, if the tube comes out before a month, the healthcare provider may check for the tube's condition. If the tube is soft and not damaged, it can be rinsed and placed back into the stomach.

New tubes are placed if the end of the tube becomes hard or damaged. The tube feeding is continuous until the baby can feed themselves or until any interventions are done to resolve the feeding difficulties.

If a baby needs feeding tubes for a longer duration due to medical conditions, pediatricians may opt to place a gastronomy tube or G-tube instead of a nasogastric or orogastric tube. This is established through small surgical procedures and kept until the baby requires it.

1. Can a baby be discharged with a feeding tube?

Yes, your baby can be discharged with a feeding tube, but you must be prepared to feed and care for your baby. You can also request the assistance of a nurse when changing the feeding tube at home (5).

2. Can I be involved in caring for my baby if they are being tube fed?

Yes, you and your partner can be involved in taking care of your baby with a feeding tube if you're comfortable enough. With the help of a neonatal nurse, you can eventually gain confidence in positioning the baby and the tube before feeding, correctly administering tube feeds, and also practicing skin-to-skin contact with your baby if possible (5).

Feeding tubes for infants can help as they tend to have gastrointestinal issues and difficulty swallowing their food. Therefore, you may consider using it to feed your little one for a while. However, once they grow up a little and can eat properly, you may do away with it to check if your baby is doing fine. Lastly, if you continue using it for a long duration, ensure it is extremely clean to prevent the baby from catching any unwanted infections.

Key Pointers

  • Newborns who can't breastfeed or bottlefeed may require tube feeding.
  • Pediatricians recommend tube feeding if there is an absence or weak sucking or/and swallowing reflex, no weight gain, or gastrointestinal issues.
  • Tube feeding has several types based on the insertion point (mouth/nose) to its final location (small intestine).
  • Proper tube placement is crucial to avert the risk of issues, such as coughing, vomiting, and breathing difficulties. • Tube feeding can continue until the baby learns to feed or feeding difficulties are resolved.

References:

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Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more

Pranjul Tandon joined the Childbirth and Postpartum Professional Association (CAPPA) in 2014 to become a Certified Childbirth Educator and began the journey of her venture Womb and Beyond in 2015. She became a certified Infant Massage Instructor with the International Association of Infant Massage (IAIM) in 2017. She has expanded her skills further by being certified as a Baby Sign... more