This page deals with the practical issues of tube feeding at school. Most children with feeding tubes will also need an IEP or 504 plan to meet their needs in the school environment. Our page on Special Education discusses how these plans work, and which might be right for your child.
Many kids are tube fed at school. Some kids are able to eat orally during their school day. But, either way parents must make sure that the protocols they set in place are being followed.
Write it into the IEP or 504 Plan
We have detailed information on IEPs and 504 Plans on our Special Education page. The IEP or 504 Plan is the appropriate place to describe a child’s tube feeding regime – from how they should be fed at school, be it via their feeding tube or orally. If your child needs assistance during meal-time, even for oral eating, it should be written into their IEP or 504 plan. Most schools will also require a doctor’s note, prescription, or set of instructions. For additional assistance, see also these guidelines: Resources for the Provision of Nutrition Support to Children in Educational Environments.
Give the school information on safe handling procedures:
- Clean hands before venting a child or attaching an extension set
- Wear gloves when appropriate
- Make sure that tubing is out of the way during toileting/diaper changes
- Ensure that tube sites are not touched by students
Many schools have strict policies on what they will do if a tube is pulled out. Make sure you understand the school’s policy. Some schools will have a nurse replace it, but many will not. Some will do nothing, while others will call 911 for paramedics. It is important for there to be clear directions on who to call (or how to proceed) in the event that this happens. Ideally, schools should have a trained staff member available to replace the tube immediately.
If children are active during the school day or receive physical therapy and there is going to be a possibility of sliding on the tummy or similar activities, you may want to consider protecting the tube site with an ace bandage or G-tube protective belt.
Additional Tips for School
- Write down the instructions for your child’s feeding regimen. Be specific about volume being fed, over what period of time, etc. Offer to train staff – be it a nurse, nurse assistant or aide on tube feeding your child. Make sure at least two people are trained.
- Many schools have rules about what feeding practices they will allow. Make sure you find out in advance any specific limitations your school district or school location has in place. Pump and gravity feeds are typically not a problem, but parents may encounter some issues with feeds given by syringe.
- If you are sending in supplies, make sure they are clean and clearly labeled for your child. See if the school nurse or teacher will hold back-up supplies.
- If you are sending in a venting tube to stay at school, make sure that you discuss cleaning with the school nurse, aide or staff. During the school year, you can ask that it be sent home so you can evaluate if it needs replacing.
- Make sure that food or formula is in a cool pack with an ice pack if it needs to remain cool during the day.
- If you are sending a pump and backpack, make sure that staff understand how to troubleshoot alarms. And, make it clear that turning the pump off and not feeding your child isn’t an acceptable solution.
- If your child is an oral eater, provide any information to the teacher about food allergies, unsafe foods, and aspiration risks. You can state that only food you send in should be served to your child.
- Talk to the teacher to find out if any foods will be used in art projects or if there are class cooking projects to determine what, if any, limitations your child may have from participating in those activities. Kids with allergies, or who cannot eat may need an alternate activity or materials.
- If your child has a feeding pump, it may have to be turned off during bus rides. Make sure there is a dedicated person (and a back-up) who is responsible for turning it back on.
Resources for the Provision of Nutrition Support to Children in Educational Environments, an article in Nutrition in Clinical Practice, provides comprehensive information for staff, nurses, and families. Members of the Feeding Tube Awareness Foundation staff worked with clinicians and advocates to develop the enteral portion of this article.
Feeding Tube Awareness also has a comprehensive School Training Presentation for school nurses, teachers, aides, and other school staff. It is available below as either a PDF or a Powerpoint Presentation.
Feeding Tube Awareness also has both a Field Guide and a Quick Guide for the Moog Infinity pump. The Field Guide shows how to operate the pump and navigate the full range of error messages, with easy-to-follow instructions and pictures. The Quick Guide is smaller, has all the needed instructions, and can be easily made into a small booklet for school, daycare, or caregivers.
Children are curious by nature and when given the right information from the right source, they can be very accepting of people with differences. We suggest considering giving a feeding tube presentation to children in the class. The following materials will help you create a presentation.
- Explain that for many reasons, some people aren’t able to eat or drink enough to be healthy so they need a feeding tube in order to get all the nutrients and fluids into their bodies without eating or drinking.
- Name the types of feeding tubes and go into whatever detail you feel is appropriate for the age group. It’s not necessary to explain all of these but these are the types of tubes: Nasogastric (NG), Nasojejunal (NJ), Nasoduodenal (ND), Gastrostomy (G), Gastrostomy-Jejunostomy/Gastric-Jejunal (GJ), Jejunostomy (J), Oral Gastric (OG)
- Explain how each type of tube is inserted and what type of care & maintenance each one requires.
Why do people need feeding tubes?
- Weak swallowing muscles
- Severe food allergies
- Physical disabilities (inability to feed oneself)
- Cancer (including lack of ability or desire to eat due to effects of chemo/radiation as well as inability to eat due to having parts of GI tract removed because of cancer)
- Stroke or brain injury
How do you use a feeding tube?
List supplies needed to administer a feed:
- Extension set (tubing)
- Formula/blenderized food
- Feeding pump
- Feeding set for feeding pump (bag)
Explain different feeding methods:
- Feeding pump
- Bolus/gravity feeding via syringe
Frequently Asked Questions
- Does it hurt?
- How long will _______ need a feeding tube?
- Can he/she still play like other kids?
- Can he/she go swimming with the tube in?
- Can he/she eat food by mouth?
- Any other questions?
- The details of the presentation will vary by audience. You can choose to make the presentation very specific to your child or more general.
- If your child is willing, he can show his classmates his tube. You can also show pictures of your child with her tube. Or pass around (in sealed plastic bags) samples of the tubes you talk about.
- Consider showing them a doll with a G-tube in it (Tubie Friends or Mini Buddy would be great for this purpose!).
- You can bring in all of the supplies you need for feeds (a can of formula, extension tubes, syringes, feeding pump & backpack) so that the kids can see each item as it is talked about.
- A PowerPoint presentation can work really well to organize everything together.
- Be prepared to answer lots of questions!