Tube Feeding Summary

Feeding Routes

When food is eaten, it passes through a series of protective mechanisms before reaching the stomach. The soft palate blocks the nasal cavity, folds in the pharynx prevent large food from passing, and the epiglottis closes the airway.

Food then moves into the esophagus, traveling by peristalsis into the stomach where it mixes with gastric juices.

From there, it enters the small intestine—duodenum, jejunum, and ileum—where nutrients are absorbed. Remaining waste moves into the large intestine. Tube feeding bypasses or supplements this normal process when a student cannot eat safely or efficiently by mouth.

Most Common Forms of Tube Feeding

The nasogastric (NG) tube is inserted through the nose into the stomach and is commonly used for short-term feeding.

 For longer-term feeding, a gastrostomy tube (G-tube) is surgically placed directly into the stomach through the abdominal wall.

Another option is the gastrostomy button, a small skin-level device that remains in place. It connects to extension tubing and usually includes a one-way valve to prevent leakage.

Buttons are discreet, easy to care for, and can be submerged in water, but they may clog or disconnect. Selection depends on the student’s medical condition, duration of feeding, and physician’s plan.

Types of Tube-Feeding Formulas

Formulas vary to meet medical and nutritional needs. Lactose-free formulas, such as Ensure, are most common and use soy or casein protein. Milk-based formulas taste good and are often used as supplements. Elemental formulas are designed for those with limited gastrointestinal function. Modular formulas provide single nutrients like protein to enhance other formulas. Specialty formulas target specific conditions like kidney failure. Some formulas are ready-to-use, while others require mixing with water. In certain cases, blended pureed foods mixed with water are prescribed, which add bulk to aid digestion and elimination. Formula choice depends on physician direction.

Equipment and Adaptive Equipment

Equipment includes tubes, buttons, and pumps. PVC tubes are firm, used short-term, and replaced often.

 Silicone or polyurethane tubes are softer, weighted, and less irritating, making them suitable for long-term use.

Skin-level devices, like the Bard Button or MIC-KEY, stay in place and prevent leakage with one-way valves.

Extension tubing supports feeding and decompression. Electric feeding pumps regulate flow and include alarms for kinks or resistance.

Adaptations support independence, such as holders for syringes, funnels, or pitchers with modified handles. These tools allow students to participate more fully in the feeding process according to their abilities.

 

Instructional Strategies and Modifications for Tube Feeding

Students should learn tube feeding as a self-help skill. Teachers break down the task into manageable steps—washing hands, preparing formula, attaching syringe, pouring, flushing, and clamping. Adaptations help students with physical limitations, such as holders, funnels, or AAC devices to direct others. Instructional strategies include picture prompts, step cards, or graduated prompting systems. Time-limited steps (adding formula before barrel empties) and caution steps (attaching syringe without pulling tube) require special attention. Teachers may model, shadow, or guide students physically to ensure safety. The goal is to maximize independence while ensuring safe, correct feeding practices for every student.

Tube-Feeding Problems and Emergencies

Several issues may arise. Aspiration is the most serious emergency, occurring when formula enters the lungs, leading to pneumonia or breathing distress. Other problems include tube displacement, nausea, vomiting, diarrhea, site infections, leakage, or clogs. Tube displacement requires quick replacement to prevent closure. Nausea or cramping may result from rapid feeding, air entry, or spoiled formula. Diarrhea may stem from formula rate, contamination, or illness. Infection prevention requires cleaning and daily observation for redness, drainage, or odor. Tubes may clog if not flushed properly. Each complication must be addressed according to the individualized health care plan.

Management Issues for Tube Feeding

Students’ Individualized Health Plans (IHPs) must outline the physician’s specific orders for formula type, amount, timing, preparation, and emergency guidelines. Protocols for aspiration, dislodgment, nausea, vomiting, diarrhea, and clogs should be detailed. The Individualized Education Program (IEP) may include training in tube-feeding skills, such as preparing formula, positioning correctly, flushing, administering, and equipment care. It can also involve monitoring nutrition and recognizing symptoms of problems. Depending on ability, students may participate fully, partially, or by directing others. Coordination between health professionals, educators, and families ensures safety, consistent care, and opportunities for the student to develop independence.

Moving to Feeding

Some students may gradually transition from tube feeding to oral feeding. This is guided by the physician and supported by specialists like dietitians, occupational therapists, and speech-language pathologists. Typically, one tube feeding is replaced by an oral feeding at a time to build motivation and assess intake. Students may progress through textures: liquids, thickened liquids, purees, soft foods, ground foods, and eventually regular table foods. Presentation, food quantity, and pace are important, as are preferences and positive environments free of distractions. Reinforcement and oral motor stimulation may be needed for reluctant students, ensuring safe and successful oral intake.