Nasal tubes are non-surgical and temporary tubes placed through the nose and into the stomach or intestine. The choice between nasogastric (NG), nasoduodenal (ND), and nasojejunal (NJ) tubes depends on whether your child can tolerate feeding into the stomach or not.
NG-tubes enter the body through the nose and run down the esophagus into the stomach.
ND- or NJ-tubes
ND-tubes are similar to NG-tubes, but they go through the stomach and end in the first portion of the small intestine (duodenum). NJ-tubes extend even further to the second portion of the small intestine (jejunum). Bypassing the stomach can be beneficial for those whose stomachs don’t empty well, who have chronic vomiting, or who inhale or aspirate stomach contents into the lungs.
Tips for Little Hands and Nasal Tubes
Babies and small children will often try to pull their nasal tubes out. At night, try putting mittens or socks on your child’s hands to keep him/her from pulling the tube out. You can tape the nasal tube (or feeding bag tubing) down the back of the shirt during the day to keep it out of the child’s way. At night, you may want to tape it further down the pajamas. If the pajamas are two-piece, you can run tubing inside the pajama leg to keep children from tangling.
Nasal Tube Considerations
They are non-surgical and temporary.
They are a good way to quickly get infants and children the nutritional benefits of tube feeding.
They can be helpful in determining if longer-term tube feeding will be beneficial.
Nasal tubes need to be taped to the cheek, which can be irritating to some children.
Little hands often succeed in pulling nasal tubes out. Make sure you discuss accidental removal with your doctor and have a replacement plan, because it will happen.
You may see increased nasal congestion, especially in infants.
Nasal tubes can make reflux, gagging, and oral aversions worse.
Nasal tubes can clog easily because they are very narrow. This is unlikely to happen with regular feeding, but may happen with medications that aren’t in liquid form. If your child has any medications that need to be crushed, discuss with your doctors if there is a liquid, compounded, or dissolvable form that can be used.
Some hospitals do not let infants or children go home with nasal tubes. Discuss this with your doctor in advance (if possible).
Nasal tubes are intended for short-term use. They need to be changed every 3 days to 4 weeks, depending on the type of tube. If longer-term tube feeding is needed, it may be time to discuss a G-tube (gastrostomy tube) that is placed directly into the stomach.
Nasal tubes are highly visible since they are taped to the face. They may draw unwanted attention because few people know what they are. They may also be confused with oxygen, since that is the reference point most people have when they see a tube near the nose.
Questions to Ask
Will it be an NG-, ND-, or NJ-tube?
Will we leave the hospital with this tube?
What should I do if the tube is pulled out?
How long will this tube be in place?
How often do we need to replace it?
How do we replace it?
At what point do we need to consider a more permanent tube, such as a G-tube?
Do I need to check placement before feeding or giving medication?
How do I check the placement?
Life at Home with a Nasal Tube
Parents and caregivers can learn how to place, or “drop,” an NG-tube at home. You will need to be taught by a medical professional, because the correct placement is very important. Learning to replace the tube yourself makes it a lot easier to do routine changes and replace a tube that gets pulled out at home. You will need to check the placement of the nasal tube after you insert it. It is a good idea to confirm placement before the start of each feed and if your child vomits forcefully. You can get more information on NG tube placement, including videos, on our NG Tube Placement and Verification page.
Taping the tube properly to the face can also make a world of difference. Learn how on our Taping Nasal Tubes page.
NJ-tubes, and some ND-tubes, need to be placed by a radiologist with X-ray guidance to ensure correct placement. They cannot be changed at home.
NG-Tube Placement and Verification
Hospitals and physicians have different methods for measuring, placing, and checking placement of NG-tubes. Always follow the method that your physician, nurse, or hospital has taught you! If you have any questions about measurement, placement, or checking placement, contact your physician, nurse, or hospital.
Your doctor or nurse will teach you how to place your child’s NG-tube. Make sure you practice placing it a few times in the hospital or doctor’s office, until you are fully comfortable with doing it on your own.
The most important thing to remember when placing an NG-tube is to keep your child as still and quiet as possible. It is best to have two people available to place the tube, whenever possible. One person can hold the child, while the other inserts the tube. If two people are not available, try swaddling your baby or wrapping your older child up like a burrito to prevent little hands from grabbing the tube as you insert it.
When inserting the tube, place your child on a flat surface where there is no fall risk. Some parents prefer to change the tube with their child on a blanket on the floor.
If you have been instructed to remeasure your child before inserting the tube, follow your doctor or nurse’s procedures for measuring. Mark or locate how far you want to insert the tube. Apply water or lubricant to the tube and then quickly insert it into the nare (nostril), with a slightly downward and inward angle to the depth your doctor or nurse has told you is correct. If your child immediately starts coughing uncontrollably or is having difficulty breathing, remove the tube, because it may have been placed into the respiratory tract.
Once the tube is in place, secure it at least partially. You can learn more about taping on our Taping Nasal Tubes page.
Verify that the tube is correctly placed by following your doctor or nurse’s instruction for verifying the placement of the tube.
How To Verify Placement
You will need to check the placement of the nasal tube after you insert it. It is a good idea to confirm placement before the start of each feed and if your child vomits forcefully. Some NG-tubes have numbers on the side that allow you to see if they have moved. Or you can mark the tube before placement so that you can tell if it has been partially pulled out.
Your doctors and nurses will discuss different methods for confirming tube placement. The current recommended method is to draw back stomach contents using a syringe, and checking the pH of the contents.
NJ-tubes, and most ND-tubes, need to be placed by a radiologist with X-ray guidance to ensure correct placement. They cannot be changed at home.
Taping Nasal Tubes
Taping is an art, and there is definitely a process of trial and error to find what works best for you and your child. Often a piece of an extra thin dressing called Duoderm is placed on the skin, the nasal tube is run on top of it, and then a clear Tegaderm dressing is applied on top.
Here is a common method:
Prior to placing the NG-tube, clean and dry the cheek and apply a piece of Duoderm Extra Thin to the cheek.
Insert the tube and lay it on top of the Duoderm.
Secure the tube to the Duoderm with a piece of Tegaderm.
Add a small strip of tape closer to the nose (Durapore works well for this).
Tape tube to clothing at the back of the neck to keep the end of the tube accessible.
Please note: Specific products may not be available from all home care companies or covered by every insurance plan.