Enteral nutrition - child - managing problems

Enteral feeding is a way to feed your child using a feeding tube. Enteral feedings will become easier for you to do with practice. Your health care provider will go over all of the steps you should follow to deliver the feedings.

You will learn how to care for the tube and the skin, flush the tube, and set up the bolus or pump feedings.

Sometimes a feeding does not go as planned, and you may have a minor problem. Your provider will go over all of the things that can happen and what you should do.

Follow your instructions on how to solve problems if they come up. Below are some general guidelines.

If the tube is clogged or plugged:

• Flush the tube with warm water.
• If you have a nasogastric tube, remove and replace the tube (you will need to measure again).
• Use a special lubricant (for example, ClogZapper) if your provider has told you to use one.
• Make sure any medicines are crushed properly to prevent clogging.

If the child coughs or gags when you insert the nasogastric tube:

• Pinch the tube, and pull it out.
• Comfort your child, and then try again.
• Make sure you are inserting the tube the right way.
• Make sure your child is sitting up.
• Check the tube placement.

If your child has diarrhea and cramping:

• Make sure the formula is mixed properly and warm.
• Do not use formula that has been hanging for feeding for more than 4 hours.
• Slow the feeding rate or take a short break. (Make sure you flush the tube with warm water in between breaks.)
• Check with your provider about antibiotics or other medicines that may be causing it.
• Start feeding when your child feels better.

If your child has an upset stomach or is vomiting:

• Make sure the formula is mixed properly and warm.
• Make sure your child is sitting up during feedings.
• Do not use formula that has been hanging for feeding for more than 4 hours.
• Slow the feeding rate or take a short break. (Make sure you flush the tube with warm water in between breaks.)
• Start feeding when your child feels better.

If your child is constipated:

• Take a break from feeding.
• Check with your provider about choice of formula and adding more fiber.

If your child is dried out (dehydrated), ask your provider about changing formula or adding additional water.

If your child is losing weight, ask your provider about changing formula or adding more feedings.

If your child has a nasogastric tube and the skin is irritated:

• Keep the area around the nose clean and dry.
• Tape down over the nose, not up.
• Switch nostrils at each feeding.
• Ask your provider about a smaller tube.

If your child's Corpak feeding tube falls out, call your child's provider. Do not replace it yourself.

Contact the provider if you notice your child has:

• Fever
• Diarrhea, cramping, or bloating that does not go away
• Excessive crying and your child is hard to console
• Nausea or vomits frequently
• Weight loss
• Constipation
• Skin irritation

If your child has trouble breathing, call 911 or the local emergency number.

La Charite J. Nutrition and growth. In: Kleinman K, Mcdaniel L, Molloy M, eds. Harriet Lane Handbook, The. 22nd ed. Philadelphia, PA: Elsevier; 2021:chap 21.

LeLeiko NS, Shapiro JM, Cerezo CS, Pinkos BA. Enteral nutrition. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 89.

van Zanten ARH. Nutritional support. In: Vincent J-L, Moore FA, Bellomo R, Marini JJ, eds. Textbook of Critical Care. 8th ed. Philadelphia, PA: Elsevier; 2024:chap 41. 

Updated by: Charles I. Schwartz MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.