GAVAGE FEEDING

(GA-VAH-JAH)

CONTENT

Purpose of gavage feeding

Supplies for feeding

Inserting the tube

Checking tube position

Feeding

Removing tube

Cleaning and storing supplies

Mouth care

Problems/Hazards

Tips

Increasing feedings

Other information

Supplies

PUPROSE OF GAVAGE FEEDING

1.Gavage feeding is a way to feed babies who are not able to suck or swallow enough for good nutrition.

2.Your baby may have a problem with his heart, esophagus (feeding canal), or his mouth—such as a cleft palate. This makes it harder for him to suck and/or swallow well.

3.Breathing and lung problems may also make it harder for your baby to suck and/or swallow well.

4.Most babies are able to eat normally after their medical problems improve.

SUPPLIES FOR FEEDING

1.Gather all equipment before beginning feeding:

a.Formula/breastmilk

b.Tape

c.Plastic bottle

d.30-60 cc leur lock tip syringe

e.Pacifier

f.#8 Fr feeding tube (15 inch) (for insertion in the mouth)

g.#3.5 Fr feeding tube (for insertion in the nose)

h.Stethoscope.

INSERTING THE TUBE

  1. Place baby on his back and measure length

a.If your baby is active, wrap him in a blanket before inserting the tube.

  1. To place tube in the mouth (oral) or nose (nasal):

a.Measure from nose to mid-ear and from mid-ear to tip of the breastbone

b.Mark spot on tube with tape.

  1. Use the natural bend of the tube to follow the curves of the mouth and throat for easy insertion.
  1. Insert the tube in the nose or mouth and toward the back of the throat. Gently push it down the esophagus (feeding canal) until you reach the tape marker on the tube.
  1. Tape the tube to the side of the mouth or upper lip.

CHECK THE TUBE POSITON & RESIDUALS

  1. Connect syringe to feeding tube.
  1. Place stethoscope over baby’s stomach and rapidly inject 2-3 cc’s of air. Listen for a whoosh. Pull back on the syringe’s plunger to withdraw air injected.
  1. At the same time you withdraw the air, any feeding (residuals) left in the stomach will also be withdrawn.

a.DO NOT throw this away. Slowly push the feeding back into the baby’s stomach but not the air

b.The feeding contains important nutrients

c.If more than 15-20 cc’s of feeding are present call the doctor for a possible change in feedings.

  1. Tube position must be checked before each feeding.

FEEDING

  1. Make the baby comfortable: change diaper; suction if needed; offer pacifier; place in infant seat or on bed with head elevated.
  1. Unclamp gavage tube.
  1. Remove the plunger from the syringe. Put the syringe into the open end of the gavage tube.
  1. Check for: tube position and feeding left in stomach before feeding.
  1. Pinch tube closed. Hold syringe upright.
  1. Pour feeding into the syringe and add any medications. Release the tube and let the feeding begin to flow. Some parents measure the feeding for each feeding into a plastic bottle instead of directly into syringe.
  1. To start the feeding, a gentle push with the plunger may be needed.
  1. Add more feeding as the syringe empties. To prevent air from getting into the stomach, do not let syringe run dry.
  1. Feeding should run at 2-3 cc’s/minute or be finished in about 20 minutes.
  1. Offer pacifier to baby during tube feeding so he will associate sucking with being fed.
  1. Feeding should FLOW BY GRAVITY, SLOWLY (hold syringe above your baby)!
  1. When feeding is finished, tube may be flushed with 3-5 cc’s of air to clear the tubing of feeding.
  1. Baby may need to be burped.
  1. Position the baby comfortably on his back or right side after feeding, unless ordered differently by the baby’s doctor.
  1. A Feeding tube may be left in place for several feedings or left in place for up to 24 hours.

a.If your baby gags on the feeding tube, remove the feeding tube following each feeding.

REMOVING TUBE

  1. Remove tape from baby’s face.
  1. Pinch tube closed and pull it out quickly.

CLEANING AND STORING EQUIPMENT

  1. Wash syringes, feeding tubes and plastic bottles with hot soapy water; rinse with hot water, air dry.
  1. Tubes may be washed and re-used.
  1. Store in clean towel when dry.

MOUTH CARE

1.It may be necessary to clean the baby’s nose and mouth with cotton swabs and warm water to keep his/her mouth and nose clean.

PROBLEMS/HAZARDS

  1. Bloody or green tinged residuals (feeding left in stomach from last feeding).

a.Remove tube and call the baby’s doctor.

  1. Baby gags or becomes restless during feeding.

a.Pinch tube and allow rest period.

  1. Baby spits, vomits, changes color or coughs.

a.Pinch tube, stop feeding and remove tube

b.Allow baby to rest

c.Call the baby’s doctor if the baby does not get better.

  1. Tube may curl up in back of the throat, come out of the mouth or come out either nostril during insertion.

a.Remove tube and reinsert.

TIPS

  1. Parents may want to use a different nostril with each tube change.
  1. Salt water nose drop may help if a stuffy nose (nasal congestion) occurs.
  1. If baby is given part of his feeding by bottle, place the tube in his nose so it does not interfere with bottle feeding.
  1. Remember: The higher the tube is held, the faster the flow of the feeding. Do not feed the baby too fast!!!!

INCREASING FEEEDINGS

  1. Your doctor will tell you how much and when to increase your baby’s feedings. Feedings are increased according to weight gained and calories needed for growth.
  1. Weigh your baby once a week (or as instructed by your doctor) at the doctor’s office or Health Department.
  1. Do not increase your baby’s feedings until told to do so by the baby’s doctor.

OTHER INFORMATION

  1. Babies on gavage feedings have visiting nurses or Health Department referrals to help with questions or problems when you go home.
  1. If your baby cries or strains to have a bowel movement during the feeding, formula may back up into the syringe.

a.Pinch the tube closed briefly

b.Help calm your baby

c.Restart the feeding when he is relaxed and quiet.

  1. You may hold your baby during the feeding when you feel comfortable with gavage feeding.
  1. Feeding by bottle should be tried before tube feeding when your baby is allowed to bottle feed part of the feeding.

SUPPLIES

  1. The hospital makes arrangements with a supply company near where you live to get the supplies you will need. The supply company will contact you at home.
  1. Do not use your home supplies while your baby is in the hospital.
  1. Call the supply company if your equipment breaks or to reorder supplies.
  1. Families with insurance should call the company or caseworker before reordering supplies. The insurance company will tell you how they want this done. They work with the supply company to make sure you have what your baby needs.

Reviewed/Revised: 09/98…..06/13

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