Tube Feeding

The Tube Feeding handout explains how tube feeding is used when students cannot safely eat by mouth, describing common feeding routes such as nasogastric tubes (short-term), gastrostomy tubes, and gastrostomy buttons (long-term options). It reviews the types of formulas prescribed—lactose-free, milk-based, elemental, modular, specialty, or pureed food mixtures—chosen based on medical needs. Equipment includes the tubes themselves and sometimes electric pumps to control feeding rates. Students are encouraged to participate in tube feeding as independently as possible, with teachers using task analysis, adaptive tools, and instructional strategies to support learning. The handout also covers potential problems and emergencies, such as aspiration, tube displacement, nausea, vomiting, diarrhea, site infections, leaks, and clogs, with prevention and response steps highlighted. Individualized Health Plans (IHPs) must outline feeding instructions and emergency protocols, while Individualized Educational Programs (IEPs) may set goals for independence in feeding skills. Finally, the document addresses transitioning from tube to oral feeding, recommending gradual replacement of tube feedings with oral meals, progression through food textures, and attention to food presentation, preferences, and supportive environments under the guidance of therapists.

1. Feeding Routes 

• Normally, food travels from mouth → pharynx → esophagus → stomach → intestines. 

• Tube feeding bypasses oral feeding. Common types: 

• - Nasogastric tube (NG tube): Inserted through nose into stomach; short-term use. 

• - Gastrostomy tube (G-tube): Inserted through abdominal wall into stomach; long-term use. 

• - Gastrostomy button (skin-level device): Low-profile, cosmetically pleasing alternative for long-term use. 

2. Tube-Feeding Formulas 

• Types of formulas: 

• - Lactose-free (most common). 

• - Milk-based (often for supplements). 

• - Elemental (for impaired digestion). 

• - Modular (single nutrient supplement). 

• - Specialty (for specific conditions, e.g., kidney failure). 

• May also include pureed food mixed with water. 

3. Equipment 

• - Tubes: PVC (short-term), silicone/polyurethane (longer-term), gastrostomy buttons (e.g., Bard Button, MIC-KEY). 

• - Feeding pumps: Deliver formula at controlled rates; alarms alert for issues. 

4. Instructional Strategies 

• - Students should be taught self-feeding skills as independently as possible. 

• - Task analysis breaks feeding into steps (e.g., handwashing, preparing formula, clamping tube, administering formula). 

• - Adaptations: holders for syringe barrels, funnels, adaptive handles, or AAC devices for directing others. 

• - Teachers should highlight time-limited steps (e.g., clamping to prevent air entry) and caution steps (e.g., attaching syringe barrel safely). 

5. Problems & Emergencies 

• - Aspiration: Emergency; can cause pneumonia or respiratory distress. Prevention: correct tube placement, proper positioning. 

• - Tube displacement: Must be replaced quickly; keep site covered. 

• - Nausea, vomiting, cramping: May result from rapid delivery, air, overfeeding, cold/contaminated formula. 

• - Diarrhea: May be due to rate, formula content, contamination, or illness. 

• - Site infections: Prevented with daily cleaning; watch for redness, odor, drainage. 

• - Leaks: May result from loose clamps or faulty valves. 

• - Clogs: Prevented with flushing water before/after feeds and meds. 

6. Management Issues 

• - Individualized Health Plan (IHP): Must specify exact tube-feeding orders, formula, frequency, and emergency protocols. 

• - Individualized Educational Program (IEP): Should include instruction in tube-feeding skills (independence, care, problem-solving). 

7. Transitioning to Oral Feeding 

• - Done gradually by replacing tube feedings with oral meals. 

• - Progression often starts with liquids → soft/pureed foods → table foods. 

• - Must consider food textures, pacing, preferences, and environment. 

• - Therapists often guide oral motor training and feeding programs. 

 

Summary: 

The handout emphasizes safe administration of tube feeding, prevention and management of complications, promoting independence in self-feeding skills, and supporting gradual transition to oral feeding when possible.