🧒🧪 Nasogastric (NG) Tubes in Children: A Parent-Friendly Guide

✅ A nasogastric (NG) tube is a soft, thin tube that goes through the nose into the stomach.
It’s used for short-term feeding, hydration, or medicines when a child can’t meet needs by mouth.
NG tubes are temporary and often used while children recover or while a longer plan is decided.

1) 🧾 Quick “At-a-glance” box (top of page)

✅ Topic: Nasogastric (NG) Tubes
Common names: NG tube, nose-to-stomach feeding tube

Plain-language summary (2–3 lines):
An NG tube delivers nutrition, fluids, or medications directly into the stomach through the nose. It’s commonly used short term—for illness recovery, feeding difficulties, or while planning next steps.

Who it affects (typical ages):
Infants, children, and teens.

✅ What parents should do today:

• Learn how tube position is checked
• Know your child’s feeding schedule and flushing plan
• Watch for tube movement or skin irritation
• Keep tape/securement supplies handy

⚠️ Red flags needing urgent/ER care:

• Sudden breathing trouble, coughing fits during feeds
• Tube comes out and you’re unsure about reinsertion
• Severe belly pain, swelling, repeated vomiting
• Lethargy with dehydration signs

🟡 When to see the clinic urgently (same/next day):

• Frequent gagging/vomiting with feeds
• Persistent nasal skin breakdown
• Repeated tube dislodgement
• Poor tolerance despite plan adjustments

2) 🧠 What it is (plain language)

An NG tube is:

• temporary
• placed through the nose → throat → stomach
• used for:
  • full feeds or top-ups
  • hydration
  • medications

It does not require surgery and can often be placed at the bedside or clinic.

What part of the body is involved? (small diagram required)

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Common myths vs facts

• Myth: “NG tubes are permanent.”
  Fact: They’re usually short-term.
• Myth: “Kids can’t eat by mouth with an NG tube.”
  Fact: Many children continue safe oral intake as advised.
• Myth: “If feeds cause gagging, the tube must be wrong.”
  Fact: Rate/volume, reflux, or sensitivity often explain symptoms.

3) 🧩 Why an NG tube is used (causes & triggers)

Common reasons

• poor intake during illness
• temporary feeding difficulties
• recovery after surgery
• weight loss or dehydration
• medication delivery when oral refusal occurs

Less common but important reasons

• bridging support while deciding on longer-term options
• short bowel or GI flare recovery (selected cases)

Triggers that worsen tolerance

• feeding too fast
• large volumes
• lying flat during feeds
• constipation or reflux

4) 👀 What parents might notice (symptoms)

• reduced gagging after plan adjustments
• nasal irritation where tape sits
• occasional coughing with feeds (should improve with position/rate)
• better energy and hydration as nutrition improves

What’s normal vs what’s not

🟢 Often normal:

• mild gagging initially that improves
• brief nausea during first days

⚠️ Not normal:

• persistent coughing/choking during feeds
• breathing distress
• repeated vomiting with pain
• poor weight gain despite feeds

Trackers

• feed volume/rate
• vomiting or coughing episodes
• stool pattern (constipation affects tolerance)
• daily weights (only if directed)

5) 🏠 Home care and what helps (step-by-step)

✅ Consistency and positioning matter most.

Daily care basics

✅ Do this now:

• Wash hands before handling tube
• Check tube marking/length before every feed
• Keep child upright during feeds and for the advised time after
• Flush tube before/after feeds and medicines (per plan)
• Secure tube to prevent pulling

Feeding tips

• start feeds slowly; advance as directed
• pause if gagging; resume once settled
• vent if instructed and trained

Skin care

• rotate tape position on the cheek
• keep skin clean and dry
• use barrier film if recommended

What usually makes it worse

• rushing feeds
• feeding while lying flat
• skipping flushes
• untreated constipation

6) ⛔ What NOT to do (common mistakes)

• Don’t feed if tube position is uncertain.
• Don’t force flush a blocked tube.
• Don’t change feed concentration or rate without guidance.
• Don’t ignore repeated gagging/coughing—report it.

7) 🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• breathing trouble or blue color
• severe choking during feeds
• collapse or unresponsiveness

🟠 Same-day urgent visit

• repeated vomiting with pain
• suspected aspiration
• significant dehydration

🟡 Book a routine appointment

• ongoing nasal skin issues
• frequent tube dislodgement
• slow weight gain

🟢 Watch at home

• mild initial gagging improving with plan changes

8) 🩺 How clinicians check safety (what to expect)

What they will ask

• feed schedule and rate
• symptoms during/after feeds
• tube securement and position checks
• stool pattern and reflux symptoms

Position checks

• checking external length/mark
• pH testing or imaging (per local policy)

What tests are usually not needed

9) 🧰 Treatment options (adjustments)

First-line fixes

• slow the rate
• reduce volume and increase frequency
• optimize upright positioning
• treat constipation/reflux if present

If not improving

• reassess tube size/type
• temporary feed changes
• consider alternate routes if NG is not tolerated long term (specialist decision)

Severe cases

• hospital monitoring for aspiration risk or dehydration

10) ⏳ Expected course & prognosis

• many children improve intake/energy within days
• NG tubes are often removed once oral intake recovers
• some children transition to other supports if needed

11) ⚠️ Complications (brief)

• nasal irritation or sores
• gagging or vomiting
• tube dislodgement
• aspiration (rare with proper checks and positioning)

12) 🛡️ Prevention and reducing problems

• careful position checks
• upright feeding
• consistent routines
• early treatment of constipation/reflux

13) 🌟 Special situations

Infants

Smaller volumes, slower rates; frequent reassessment.

Teens

Privacy and autonomy; teach self-checks when appropriate.

Chronic conditions

Higher needs; close coordination with dietitian.

Neurodevelopmental differences/autism

Predictable routines; sensory-friendly taping options.

Travel

Carry spare tape, syringes, and written plan.

School/daycare

Provide feeding schedule and who to call if tube issues occur.

14) 📅 Follow-up plan

• regular weight checks
• reassess need for NG tube
• earlier review if:
  • vomiting worsens
  • coughing during feeds persists
  • weight gain stalls

15) ❓ Parent FAQs (NG-tube–specific)

“How do I know the tube is in the right place?”

Follow your team’s position-check method every time (mark/length ± pH). If unsure, don’t feed and seek guidance.

“Why does my child gag with feeds?”

Common causes include fast rate, large volume, reflux, or sensitivity. Adjustments usually help.

“Can my child still eat by mouth?”

Often yes—if swallowing is safe and approved by your team.

“How long will my child need an NG tube?”

Usually short term. Duration depends on recovery and feeding goals.

“What if the tube keeps coming out?”

Securement changes and cheek rotation help; frequent dislodgement should be reviewed.

16) 🧾 Printable tools (high-value add-ons)

🧾 Printable: NG Tube Daily Checklist

• Check tube position/mark
• Upright during feeds
• Flush before/after feeds & meds
• Inspect nasal skin

🧾 Printable: Feed & Symptom Log

Date: ______
Feed volume/rate: ______
Gagging/coughing: yes/no
Vomiting: yes/no
Notes: _______________________

🧾 Printable: “Red Flags” Sheet

⚠️ Urgent: breathing trouble, severe choking, uncertain tube position.

17) 📚 Credible sources + last updated date

Trusted references:

• Children’s hospital enteral feeding education pages
• Pediatric nutrition and GI society resources

Last reviewed/updated on: 2025-12-31
Protocols vary by center—follow your clinic’s instructions.

🧡 Safety disclaimer

This guide supports—not replaces—medical care. If you are worried about your child, trust your instincts and seek urgent medical assessment.

This guide was fully developed & reviewed by Dr. Mohammad Hussein, MD, FRCPC ROYAL COLLEGE–CERTIFIED PEDIATRICIAN & PEDIATRIC GASTROENTEROLOGIST Board-certified pediatrician and pediatric gastroenterologist (Royal College of Physicians and Surgeons of Canada) with expertise in inflammatory bowel disease, eosinophilic gastrointestinal disorders, motility and functional testing, and complex nutrition across diverse international practice settings.

To book an online assessment Email Dr. Hussein’s Assistant Elizabeth Gray at: Elizabeth.Gray@pedsgimind.ca
In the email subject, please write: New Assessment Appointment with Dr. Hussein

Important: This appointment is completely online as Dr. Hussein is currently working overseas. This service is not covered by OHIP