Nasogastric Tubes

A nasogastric (NG) tube is a long, thin, flexible tube that is inserted into one nostril and passed through the esophagus, with the tip ending in the stomach. An NG tube helps deliver nutrition and fluids to a child if they are unable to consume enough by mouth. NG tubes can be used to deliver some or all of a child’s nutrition and hydration needs.

NG tubes come in different sizes depending on the size of the child. NG tubes can have a weight at the tip to help keep the tube in place.

There are many different reasons why your child may need an NG tube, including:

• Premature infants—Often an NG tube [or an orogastric (OG) tube, which is placed in the mouth, passed through the esophagus, and ends in the stomach] is used to provide supplemental nutrition to premature infants. Sometimes the infant can have underdeveloped or limited skills to coordinate sucking, swallowing, and breathing. An NG tube also can help decrease the energy required for an infant to feed orally.
• Malnutrition—When infants and children are not meeting their growth milestones or have lost significant weight, a medical professional may request a NG tube to help provide enough nutrition for proper growth.
• Dysphagia—Infants and children who cannot safely swallow liquids may need an NG tube.
• Medications—In certain circumstances, children may need an NG tube to deliver important medications. 
• NG tubes are sometimes used to help suction materials out of the stomach. This can happen if children have a bowel blockage or delayed movement of contents through the intestines.

A NG is a temporary feeding method. The amount of time your child will have a NG tube varies and will depend on your child’s medical condition and the medical institution. If long-term nutrition is needed, your medical professional may discuss placing a gastrostomy tube (G-tube).

An NG tube is inserted through the nostril, down through the esophagus, and into the stomach. Your medical professional will first measure how long of a tube your child needs. The medical professional may place a lubricant on the tip of the tube to help it glide easier during placement.

The NG tube is placed while your child is awake. Your medical professional will then check to make sure the tube is correctly placed by taking an X-ray or by collecting a sample of fluid from the stomach through the tube. After the tube is properly placed, it is held in place using tape or an NG tube holder. The tube is then ready to use for feeding or hydration.

Children usually spend a night in the hospital when a new NG tube is placed. Parents are taught how to use the NG tube and how to replace it if it becomes dislodged at home. If the NG tube becomes dislodged, it will need to be replaced and its placement verified again before delivering any liquids.

Attention and care to the nostril and cheek where the tube is located are important to prevent damage to the skin.

• Improper placement—The NG tube tip can end up in the lungs, esophagus, or in the small intestine. Verifying correct placement of the tube helps decrease these risks. If the tube is placed in the lungs or is pulled out during a feeding, then the child is at risk of aspiration pneumonia.
• Bloody nose—The NG tube can cause irritation to the nostril, and it may bleed more often than without the tube.
• Vomiting—Sometimes the NG tube can cause vomiting due to its placement in the back of the throat and esophagus. Increased volume or speed of feeding also may initially cause vomiting.
• Perforation—Any foreign object entering the body has a risk of creating a hole, called a perforation. However, this risk is low for NG tubes.

If parents are having difficulty replacing the NG tube, the child is having difficulty tolerating NG tube feedings, or if there is concern about tube placement, you should contact your medical professional for further guidance.

References
Irving, S et al. (2018). Pediatric Nasogastric Tube Placement and Verification: Best Practice Recommendations from the NOVEL project.  Nutrition in Clinical Practice, 33(6), 921-927.

Benioff Childrens Hospital. (n.d).  Gastric Suction.  Retrieved April 30th 2020, from ucsfbenioffchildrens.org

Arvedson, J & Brodsky, L. (2002). Pediatric Swallowing and Feeding, Second Edition. Clifton Park, NY: Delmar.

Authors: Mary Enenbach CPNP, Kathryn Rowell, FNP
Date Reviewed: 5/2021