Tube Feeding: Everything You Need to Know
Feeding tubes can be a lifesaver for babies who are unable to take enough nutrition safely by mouth. They provide essential support while a baby recovers from illness, surgery, prematurity or other medical conditions. This article explains the main types of feeding tube, why babies sometimes need them, and how tube feeding can affect feeding skills and hunger over time.
Key points
- Feeding tubes are vital when a baby cannot safely or effectively feed orally, or cannot take enough to support healthy growth.
- The most common types are NG tubes, G tubes and J tubes, each used for different time frames and medical needs.
- While tube feeding prevents malnutrition, long term use can reduce hunger, limit oral skills and increase the risk of tube dependence.
- Careful planning, regular review and support for oral skills can help protect a baby’s long term feeding and growth.
Table of contents
Types of feeding tubes Why some babies need tube feeding Advantages of tube feeding Disadvantages of tube feeding Combining tube feeding and oral feeding How tube feeding can affect hunger and feeding skills When to seek professional helpTypes of feeding tubes
The type of feeding tube used usually depends on how long a baby is expected to require feeding support and the reason support is needed. There can also be individual factors that make one tube a better choice than another.
The three most commonly used feeding tubes are:
NG tube (nasogastric tube): An NG tube is inserted into the baby’s stomach through the nose. The tube is either secured in place by taping it to the baby’s face or it can be inserted for each feeding. An NG tube is usually chosen when tube feeding is needed for a short time, usually less than three months. For example, for a preterm baby or after heart surgery.
G tube (gastrostomy tube, also called PEG tube): A G tube is inserted into the baby’s stomach through the abdomen. A G tube is usually used when a baby is expected to need feeding support for longer than three months.
J tube (jejunostomy tube or PEJ tube): A J tube is inserted through the abdomen directly into the small intestine, bypassing the stomach. A J tube may be chosen instead of a G tube when there is severe gastroesophageal reflux related to delayed emptying of stomach contents.
Why some babies need tube feeding
Some babies require tube feeding from birth. Others start out feeding orally but are unable to maintain adequate growth because of an underlying medical condition or unresolved feeding problem. Common reasons include:
- Sucking and swallowing problems due to prematurity or brain conditions.
- Birth differences that affect the mouth, jaw, throat, stomach or intestines.
- Cardiac and lung conditions that cause extreme fatigue.
- Post operative support while a baby recovers from surgery.
- Metabolic disorders that require an unpleasant tasting diet or medications.
- Severe gastroesophageal reflux disease (GERD).
- Failure to thrive due to physical, social or behavioural factors.
About 80 percent of babies labelled as having failure to thrive have no underlying physical cause. An unresolved feeding aversion can lead to poor growth.
Advantages of tube feeding
When a baby cannot safely or effectively feed by mouth, tube feeding offers important benefits.
- Prevents malnutrition and excessive fatigue.
- Reduces the risk of aspiration while feeding.
- Allows the baby to receive adequate nutrition without being pressured to eat more than he is able to manage orally.
Disadvantages of tube feeding
NG tube
- Insertion can be painful and distressing.
- Risk of bleeding in the nasal passage, ulceration, laryngeal injury and throat discomfort.
- Nasal congestion and irritation.
- Discomfort while swallowing.
- Baby’s hands may need to be restrained to prevent him from pulling the tube out.
- Others may view the baby as sick or disabled.
G and J tubes
- Insertion requires a surgical procedure, often with a general anaesthetic.
- Irritation and leakage around the insertion site.
- Infection around the insertion site.
Tube feeding in general
- Higher incidence of gastroesophageal reflux*.
- Reduces a baby’s natural instinct and desire to eat and drink.
- Limits opportunities to develop the oral motor skills needed for sucking, chewing and swallowing.
- Prevents the baby from self regulating intake according to growth and energy needs.
- Reduces chances to build positive associations between oral feeding and the relief of hunger.
- Can make a baby less sensitive to internal messages of hunger and fullness.
- Increases the risk of tube dependence.
- Can be a financial burden. Tube fed babies are often cared for by several health professionals, such as a paediatrician, speech therapist, occupational therapist and dietician, each requiring regular appointments.
- Creates high levels of anxiety for many parents.
For babies who cannot safely feed orally because of a physical or medical condition, the advantages of tube feeding outweigh the disadvantages.
* An NG tube allows stomach contents to flow backwards more easily. Any tube fed baby, no matter which tube is used, can be prone to regurgitation of stomach contents if overfed.
Combining tube feeding and oral feeding
Most tube fed babies have at least some ability to feed orally. When a baby has shown that he can drink or eat by mouth but is not yet able to take enough for healthy growth, parents are often advised to combine oral feeds with tube feeds.
In theory, this sounds simple. The baby is given an opportunity to feed orally first, and once he has taken as much as he can, he is then topped up through the feeding tube. The goal is to support him to practise and strengthen his oral skills so that tube feeds can eventually be reduced and then stopped.
In practice, combining oral and tube feeds is more complex. It requires a careful balance between providing enough nutrition via the tube to support growth, but not so much that hunger is suppressed and the baby has little motivation to feed orally. In general, health professionals prefer to err on the side of caution, so a child’s nutritional needs are more likely to be overestimated than underestimated.
Without hunger as a motivator, the ideal of a gradual shift toward full oral feeding can slowly reverse, with oral opportunities becoming small and symbolic while tube feeds provide most or all of the nutrition.
Any pressure placed on a baby or child to feed orally can also shift the balance toward full tube feeding. If feeding feels unpleasant, repeated pressure can lead to a feeding aversion and an even stronger preference to rely on the tube.
When oral and tube feeds are combined, small adjustments can make a big difference. Rather than increasing tube volumes at the first sign of slower growth, ask your health professional whether a short trial of slightly lower tube volumes or fewer night feeds is safe for your baby. For some children this allows a gentle rise in daytime hunger and can increase interest in oral feeding, while growth and hydration remain closely monitored.
How tube feeding can affect hunger and feeding skills
Tube feeding keeps babies nourished, but it also changes how they experience hunger and feeding. When nutrition is delivered at set times through a tube, a baby does not need to act on hunger or fullness. Over time this can affect both appetite and oral skills.
- Babies may miss sensitive developmental periods for learning to suck, chew and swallow.
- Very regular tube feeds can prevent a baby from feeling clearly hungry, so hunger is not linked with eating.
- Some babies become distressed when they finally feel strong hunger but do not yet understand how to relieve it by feeding orally.
- Others appear unaware of hunger cues and can go many hours without showing distress, which may reflect desensitisation to internal sensations.
These patterns do not mean a baby cannot learn to feed orally. They do mean that careful support is often needed to rebuild appetite, trust and skills when the time is right to move toward tube weaning.
When to seek professional help
If your baby is tube fed, regular medical review is essential. In particular, speak with your paediatrician or feeding team if you notice:
- Distress at the sight of bottles, spoons or food, or strong resistance to any attempts at oral feeding.
- Signs of possible pain during or after tube feeds, such as persistent crying, back arching or frequent vomiting.
- Very limited oral skills for age, such as no interest in mouthing toys, no attempts to chew or ongoing difficulty managing thin fluids.
- Concerns that tube volumes may be very high for your baby’s current size and activity level.
- Increasing worry or uncertainty about how and when tube feeding might be reduced.
A comprehensive feeding assessment can help identify medical, developmental and behavioural factors that may be affecting your baby’s progress and can guide a safe, individualised plan.
Written by Rowena Bennett.