Caring for your baby at home Outpatients and follow-up Frequently asked questions - Community support

Giving milk via a Nasogastric Tube to your baby at home | Gastro-oesophageal reflux (GOR)

 

In the first few weeks you may find your baby's feeding pattern is irregular. Some babies may demand more frequent feeds than they had while in the hospital. This is normal as each baby is an individual and can be fed according to his/her own needs.

 

If you offer feeds frequently and ensure your baby takes as much as they need, your baby should stop feeding when they have had enough. If you think your baby is feeding too much or too little, discuss it with one of the community team.

 

You can be sure your baby is getting enough milk if he/she has plenty of wet nappies, is growing and is alert and awake for some of the time.

 

Remember to always wash your hands before feeding your baby and, if you are bottle feeding make sure the bottle and teats are properly sterilised. Always test the heat of drink or food before giving it to your baby.

 

Giving milk via a Nasogastric Tube to your baby at home

 

Your baby may be gaining weight, maintaining his temperature and have no other significant problems but still requires using a feeding tube for some of his feeds. It is possible for your baby to be discharged home whilst he/she still needs some tube feeds. Whilst your baby is on the NICU or, SCBU, the nurses will show you how to feed via the tube. The community team will make sure that you are confident with doing this and discuss his/her feeding plan, before your baby is discharged.

 

If your baby is managing at least two full feeds independently of the tube (at the breast or by bottle) within a 24 hour period and you live in Cambridge or in any of the surrounding villages and have telephone contact we can support you at home. We provide you with all the necessary equipment for tube feeding and will visit you at home at least twice a week initially and help you with the gradual weaning from the tube.

 

Once at home your baby will begin to increase the amount he/she is taking by breast/bottle and decreases the amount given via the tube. The community team will give you guidance as to when and how this is done when they visit you. Usually it is the baby that predicts the pace.

 

 

Feeding Guidance

 

It is important to be sure of the position of the tube prior to feeding as it might have become dislodged or moved slightly. Your baby will let you know if the tube is misplaced by coughing and gagging. If your baby has pulled the tube out a little way do not put it back take it out

 

 

Checking the position of the tube

 

Make a note of the level at which the tube is placed before you go home. In this way you can always check the level of the tube before starting each feed and be fairly certain that it has not moved.

 

Before each feed:

• Using a 5ml syringe withdraw slowly a small amount of milk/fluid from your baby's stomach via the tube
  
  
• Moisten the pH paper with the milk/fluid. You should get a pH reading between 1 -5. It is now safe to proceed with the feed. If you get a pH reading of 6 or above you should not feed your baby via the tube and contact the community team. The nurses will go through this with you while you are still in the hospital and will make sure you are confident before discharging your baby
  
  
• It is recommended that you check the tube position before every tube feed
  
  
• If you cannot withdraw any milk/fluid there are a few things you can do:
  
  - Wait a few minutes and try again
  - Turn your baby onto his/her side and try again
  - Offer your baby the breast or bottle for a few minutes and then try again

 

Tube Feeding

 

1. Wash your hands and prepare the feed
   
   
2. Ensure that your baby is comfortable before starting
   
   
3. Check that the tube is still in place (see above)
   
   
4. Draw up the milk in a 10ml Nasogastric tube and then pull back the plunger until it meets resistance at the end of the barrel
   
   
5. Attach the syringe to the Nasogastric tube and withdraw the plunger. The milk may now flow easily or it might need a gentle push on the plunger to get it going. Allow the milk to descend by gravity and continue until all the feed is gone.
   
   
6. Disconnect the syringe and close the end of the tube
   
   
7. Your baby should never be left alone with the tube feed in progress. If the phone rings or another emergency happens then pour the milk back into the bottle and detach the syringe before attending to the problem.

 

What to do if the tube has come out or you cannot test it?

 

If your baby is already taking a reasonable amount by breast /bottle then don't panic. As long as he/she is able to keep the nutrition going by taking 20-30mls per feed there is no immediate cause for concern. If however you know that you have a very sleepy baby that is not taking either breast or bottle then the tube will need to be replaced fairly quickly.

• If you know the community nurse is due to visit within a few hours, wait for her/him to  arrive
  
  
• If the community team are not due to visit you should call the community office during working hours
  
  
• If your baby should pull out his tube at a weekend or evening we would advise you to phone 01223 217 681 for advice and if necessary would ask you to bring the baby back for a replacement tube

 

Changing you baby's tube

 

The tube will have to be changed once a week by you community nurse. It is a quick procedure during which your baby may experience some slight discomfort but once the tube is in place there is no distress.

 

 

Community Team visits

 

Babies who go home with a feeding tube usually have at least 2 visits a week from the community team.

 

 

We continue with the advice that is given in hospital, advice on feeding issues and give other advice pertaining to your baby's growth and development and weigh your baby. The team meet regularly with your baby's paediatrician to discuss progress.

 

When we are happy that your baby is feeding well from you or a bottle, gaining weight and thriving we hand over care to the health visitor.

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Gastro-oesophageal reflux (GOR)

 

GOR in babies is similar to heartburn in adults. Symptoms can include vomiting, gagging, and choking and tummy pain. Reflux is common in premature babies – the more premature your baby is, the more likely it is they will have GOR for a while.

 

GOR can be miserably uncomfortable for your baby, making it difficult for your baby to feed happily or to keep milk in his/her stomach afterwards. Thankfully, babies usually grow out of reflux during their first year and the reflux tends to disappear as your baby spends more time upright – first sitting up alone, then toddling and walking. Your community nurse and health visitor will be able to give you individual advice about the way your baby is feeding.

 

In general, if your baby has GOR, it may help to keep him/her as upright as possible most of the time. Try and position your baby so that their head is gently raised during the day, particularly during and after feeds. Kangaroo care or holding your baby upright after feeding may also help. At night, you could try semi-reclining your baby's mattress by standing it on something stable such as a couple of books.

 

 

 

 

 

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