Gastrostomy feeding tube - bolus

Your child's gastrostomy tube (G-tube) is a special tube in your child's stomach that will help deliver food and medicines until your child can chew and swallow. Sometimes, it is replaced by a button, called a Bard Button or MIC-KEY, 3 to 8 weeks after surgery.

These feedings will help your child grow strong and healthy. Many parents have done this with good results.

You will quickly get used to feeding your child through the tube, or button. It will take about the same time as a regular feeding, around 20 to 30 minutes. There are two ways to feed through the system: the syringe method and the gravity method. Each method is described below. Make sure you follow all of the instructions given to you by your health care provider as well.

Your provider will tell you the right mix of formula or blended feedings to use, and how often to feed your child. Have this food ready at room temperature before you start, by taking it out of the refrigerator for about 30 to 40 minutes. Do not add more formula or solid foods before you talk to your child's provider.

Feeding bags should be changed every 24 hours. All of the equipment can be cleaned with hot, soapy water and hung up to dry.

Remember to wash your hands often to prevent the spread of germs. Take good care of yourself as well, so that you can stay calm and positive, and cope with stress.

You will clean your child's skin around the G-tube 1 to 3 times a day with mild soap and water. Try to remove any drainage or crusting on the skin and tube. Be gentle. Dry the skin well with a clean towel.

The skin should heal in 2 to 3 weeks.

Your provider may also want you to put a special absorbent pad or gauze around the G-tube site. This should be changed at least daily or if it becomes wet or soiled.

Do not use any ointments, powders, or sprays around the G-tube unless told to do so by your provider.

Make sure your child is sitting up either in your arms or in a high chair.

If your child fusses or cries while feeding, pinch the tube with your fingers to stop the feeding until your child is more calm and quiet.

Feeding time is a social, happy time. Make it pleasant and fun. Your child will enjoy gentle talk and play.

Try to keep your child from pulling on the tube.

Since your child is not using their mouth yet, your provider will discuss with you other ways to allow your child to suck and develop mouth and jaw muscles.

Your provider will show you the best way to use your system without getting air into the tubes. Follow these steps first:

• Wash your hands.
• Gather your supplies (feeding set, extension set if needed for a G-button or MIC-KEY, measuring cup with spout, room temperature food, and a glass of water).
• Check that your formula or food is warm or at room temperature by putting a few droplets on your wrist.

If your child has a G-tube, close the clamp on the feeding tube.

• Hang the bag high on a hook and squeeze the drip chamber below the bag to fill it halfway with food.
• Next, open the clamp so that the food fills the long tube with no air left in the tube.
• Close the clamp.
• Insert the catheter into the G-tube.
• Open toward the clamp and adjust the feeding rate, following your provider's instructions.
• When you are finished feeding, your nurse may recommend that you add water to the tube to flush it out.
• G-tubes will then need to be clamped at the tube, and the feeding system will need to be removed.

If you are using a G-button, or MIC-KEY, system:

• Attach the feeding tube to the feeding system first, and then fill it with formula or food.
• Release the clamp when you are ready to adjust the feeding rate, following your provider's instructions.
• When you are finished feeding, your provider may recommend that you add water into the tube to the button.

Your provider will teach you the best way to use your system without getting air into the tubes. Follow these steps:

• Wash your hands.
• Gather your supplies (a syringe, feeding tube, extension set if needed for a G-button or MIC-KEY, measuring cup with spout, room temperature food, water, rubber band, clamp, and safety pin).
• Check that your formula or food is warm or at room temperature by putting a few droplets on your wrist.

If your child has a G-tube:

• Insert the syringe into the open end of the feeding tube.
• Pour the formula into the syringe until it is half full and unclamp the tube.

If you are using a G-button, or MIC-KEY, system:

• Open the flap and insert the bolus feeding tube.
• Insert the syringe into the open end of the extension set and clamp the extension set.
• Pour the food into the syringe until it is half full. Unclamp the extension set briefly to fill it full of food and then close the clamp again.
• Open the button flap and connect the extension set to the button.
• Unclamp the extension set to begin feeding.
• Hold the tip to the syringe no higher than your child's shoulders. If the food is not flowing, squeeze the tube in downward strokes to bring the food down.
• You can wrap a rubber band around the syringe and safety pin it to the top of your shirt so that your hands are free.

When you are finished feeding, your nurse may recommend that you add water to the tube to flush it out. G-tubes will then need to be clamped at the tube and the feeding system, and removed. For a G-button or MIC-KEY, you will close the clamp and then remove the tube.

If your child's belly becomes hard or swollen after a feeding, try venting, or burping the tube or button:

• Attach an empty syringe to the G-tube and unclamp it to allow air to flow out.
• Attach the extension set to the MIC-KEY button and open the tube for the air to release.
• Ask your provider for a special decompression tube for burping the Bard Button.

Sometimes you may need to give medicines to your child through the tube. Follow these guidelines:

• Try to give your child medicine before a feeding so that they work better. You may also be asked to give your child medicines on an empty stomach outside of mealtime.
• The medicine should be liquid, or finely crushed and dissolved in water, so that the tube does not get blocked. Check with your provider or pharmacist on how to do this.
• Always flush the tube with a little water between medicines. This will make sure that all the medicine goes in the stomach and is not left in the feeding tube.
• Never mix medicines.

Contact your child's provider if your child:

• Seems hungry after the feeding
• Has diarrhea after feedings
• Has a hard and swollen belly 1 hour after feedings
• Seems to be in pain
• Has changes in their condition
• Is on new medicine
• Is constipated and passing hard, dry stools

Also contact the provider if:

• The feeding tube has come out and you do not know how to replace it.
• There is leakage around the tube or system.
• There is redness or irritation on the skin area around the tube.

Feeding - gastrostomy tube - bolus; G-tube - bolus; Gastrostomy button - bolus; Bard Button - bolus; MIC-KEY - bolus

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.

Samuels LE. Nasogastric and feeding tube placement. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 40.

UCSF Department of Surgery website. Gastrostomy tubes. surgery.ucsf.edu/procedure/gastrostomy-tubes. Updated 2023. Accessed January 16, 2024.

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.