🧒👃🧪 Nasogastric (NG) Tubes: Daily Care, Safety Checks, and Troubleshooting (Parent-Friendly Guide)

✅ An NG tube is a soft tube that goes through the nose into the stomach.
It’s commonly used for short-term feeding, hydration, or medicines, especially during recovery or while deciding next steps.
The two biggest home priorities are: (1) confirming position before feeds and (2) preventing skin irritation and dislodgement.

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

✅ Topic: Nasogastric (NG) Tubes — Care & Troubleshooting
Common names: NG tube, nose tube, feeding tube through nose

Plain-language summary (2–3 lines):
NG tubes deliver nutrition directly into the stomach through the nose. Families learn how to secure the tube, check it hasn’t moved, give feeds safely, and know when to seek urgent help.

Who it affects (typical ages):
Infants, children, and teens—often short-term.

✅ What parents should do today:

• Know your center’s position-check method (mark/length ± pH)
• Feed with your child upright
• Flush as prescribed and give meds safely
• Protect nose/cheek skin and prevent pulling

⚠️ Red flags needing urgent/ER care:

• Breathing trouble or severe choking during feeds
• Tube position is uncertain and you cannot verify
• Repeated vomiting with severe belly pain or swelling
• Child becomes very sleepy with dehydration signs

🟡 When to contact clinic urgently:

• Frequent tube dislodgement
• Persistent gagging/coughing with feeds
• Worsening skin breakdown on cheek or nostril
• Poor growth or poor tolerance despite adjustments

2) 🧠 What it is (plain language)

An NG tube:

• enters nose → throat → esophagus → stomach
• is held in place by tape/securement on the cheek
• can be used for:
  • full feeds or “top-ups”
  • hydration
  • medicines

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

Common myths vs facts

• Myth: “If my child is coughing, it means the tube is definitely in the airway.”
  Fact: Coughing can be from reflux or sensitivity, but airway placement is dangerous—always follow your position-check protocol.
• Myth: “Once the tube is taped, it can’t move.”
  Fact: Tubes can shift with coughing, pulling, or play.
• Myth: “NG tube feeding always causes vomiting.”
  Fact: Many children tolerate feeds well with correct rate, volume, and positioning.

3) 🧩 Why NG tubes are used (causes & triggers)

Common reasons

• illness recovery and temporary poor intake
• post-surgery or hospital recovery
• feeding difficulties needing short-term support
• dehydration risk
• medication delivery when oral intake is unreliable

Less common but important reasons

• bridging support while planning longer-term feeding strategy

Triggers that worsen tolerance

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

4) 👀 What parents might notice

• mild gagging early on (often improves)
• cheek redness where tape sits
• occasional tube pulling (especially toddlers)
• better energy once intake improves

What’s normal vs what’s not

🟢 Often normal:

• mild nasal/cheek irritation that improves with rotation and skin care
• occasional brief gagging

⚠️ Not normal:

• persistent coughing or choking during feeds
• breathing difficulty
• repeated vomiting with pain
• tube repeatedly coming out and feeds can’t be given safely

Trackers

• feeding volumes and rate
• vomiting/gagging/coughing episodes
• stooling pattern (constipation affects tolerance)
• skin condition on cheek and nostril

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

✅ Safety comes from position checks + upright feeding + gentle securement.

Daily NG tube care routine

✅ Do this now:

• Wash hands before handling the tube
• Check the external tube marking/length before every feed
• Confirm placement using your center’s protocol (mark/length ± pH testing if trained)
• Keep your child upright during feeds and for the recommended time after
• Flush before/after feeds and medicines
• Rotate tape position on the cheek to protect skin

Helping prevent dislodgement

• use securement device or tape technique taught by your team
• keep hands busy during feeds (toy, book)
• for toddlers: consider clothing that limits access to tubing (as safe and comfortable)

What usually makes it worse

• rushed setup
• feeding while lying down
• skipping flushes
• ignoring constipation

6) ⛔ What NOT to do (common mistakes)

• Don’t feed if position is uncertain.
• Don’t force flush a blocked tube.
• Don’t change feed concentration or rate without guidance.
• Don’t retape repeatedly on the same irritated skin area—rotate sites.

7) 🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• breathing trouble, blue lips
• severe choking episode
• unresponsiveness

🟠 Same-day urgent visit

• repeated coughing/choking during feeds
• repeated vomiting with dehydration
• tube dislodged and you cannot safely replace/verify

🟡 Book a routine appointment

• frequent dislodgement
• persistent skin breakdown
• poor growth or ongoing intolerance

🟢 Watch at home

• mild irritation improving with better securement and skin care
• mild gagging that improves after rate/position adjustments

8) 🩺 How clinicians ensure NG feeding is safe (what to expect)

What they will ask

• your placement-check method and results
• symptoms during feeds (coughing, choking, vomiting)
• rate/volume schedule
• stool pattern and reflux symptoms
• skin irritation issues

Possible tests (if indicated)

• swallow assessment if aspiration risk suspected
• evaluation for reflux/constipation
• imaging if tube placement concern and protocol requires confirmation

What tests are usually not needed

9) 🧰 Treatment options (fixing common problems)

First-line fixes for vomiting/gagging

• slow the rate
• reduce volume and increase frequency
• ensure upright feeding
• treat constipation
• review reflux plan

If not improving

• reassess tube size/type
• consider alternate feeding route if NG is repeatedly not tolerated (team decision)

Severe cases (hospital care)

• dehydration
• suspected aspiration
• severe abdominal symptoms

10) ⏳ Expected course & prognosis

• many children need NG tubes for days to weeks
• NG tubes are often removed once oral intake recovers
• some children transition to longer-term options if needed

11) ⚠️ Complications (brief but clear)

Common

• skin irritation on cheek/nose
• gagging
• tube dislodgement

Less common but serious

• aspiration if tube position is incorrect or if feeding safety issues exist
• dehydration if feeds cannot be delivered

12) 🛡️ Prevention and reducing future problems

• consistent position checks
• upright feeding
• gentle securement and skin rotation
• constipation prevention and treatment
• calm feeding routines

13) 🌟 Special situations

Infants

Smaller volumes and careful pacing; reflux common.

Teens

Support autonomy; discreet securement strategies.

Chronic conditions

May need longer duration and tighter monitoring.

Neurodevelopmental differences/autism

Predictable routines; sensory-friendly tape; gradual desensitization.

Travel considerations

Carry extra tape, syringes, spare tube, and written plan.

School/daycare notes

Provide:

• feeding schedule
• who is trained to feed
• what to do if tube comes out
• emergency contact numbers

14) 📅 Follow-up plan

• regular weight checks as advised
• review need for tube and weaning plan
• earlier follow-up if:
  • coughing/choking occurs
  • skin breakdown worsens
  • vomiting increases
  • tube keeps coming out

15) ❓ Parent FAQs (NG Tube Care-Specific)

“How do I know the tube hasn’t moved?”

Use your center’s method every time (external mark/length ± pH if trained). If uncertain, don’t feed.

“My child keeps pulling the tube out—what can we do?”

Improve securement, use distractions, and consider protective clothing strategies. If frequent, discuss alternative feeding routes.

“Why does my child vomit during NG feeds?”

Common causes: rate too fast, volume too large, reflux, constipation, or illness. Small adjustments often solve it.

“Can my child still drink or eat?”

Often yes, if safe swallowing is confirmed and your team approves.

“When is it time to stop using an NG tube?”

When oral intake consistently meets needs and the medical team agrees it’s safe to remove.

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

🧾 Printable: NG Tube Daily Safety Checklist

• Position check done before each feed
• Child upright during feeds
• Flush before/after feeds & meds
• Skin checked (cheek + nostril)
• Stool pattern monitored

🧾 Printable: “Do NOT Feed If…” Sheet

⚠️ Do not feed if:

• tube mark/length looks different
• child is coughing/choking with feeds
• child has severe vomiting with sleepiness

🧾 Printable: Feed & Symptom Log

Date: ______
Feed volume/rate: ______
Vomiting: yes/no
Coughing/choking: yes/no
Stools: ______
Notes: _______________________

17) 📚 Credible sources + last updated date

Trusted references:

• Children’s hospital NG tube feeding education pages
• Pediatric enteral nutrition resources

Last reviewed/updated on: 2025-12-31
Placement-check 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