Your child has a gastrostomy tube (G-tube, or PEG tube). This is a soft, plastic tube placed into your child's stomach. It delivers nutrition (food) and medicines until your child can chew and swallow.

You'll need to learn how to give your child feedings and how to care for the G-tube. Follow any specific instructions your health care provider or nurse gives you. Use the information below as a reminder of what to do.

PEG tube feeding; PEG tube care; Feeding - gastrostomy tube - pump; G-tube - pump; Gastrostomy button - pump; Bard Button - pump; MIC-KEY - pump

Your child's G-tube may be replaced by a button, called a Bard Button or MIC-KEY, 3 to 8 weeks after surgery.

You will quickly get used to feeding your child through the tube, or button. It will take about the same time as a regular feeding, around 20 to 30 minutes. These feedings will help your child grow strong and healthy.

Your provider will tell you the right mix of formula or blended feedings to use, and how often to feed your child. To warm the food, take it out of the refrigerator 2 to 4 hours before use. Do not add more formula or solid foods before you talk to your provider or nurse.

Feeding bags should be changed every 24 hours. All of the equipment can be cleaned with hot, soapy water and hung to dry.

Remember to wash your hands regularly to prevent the spread of germs. Take good care of yourself as well, so that you can stay calm and positive, and cope with stress.

The skin around the G-tube needs to be cleaned 1 to 3 times a day with mild soap and water. Try to remove any drainage or crusting on the skin and tube. Be gentle. Dry the skin well by patting with a clean towel.

The skin should heal in 2 to 3 weeks.

Your nurse may tell you to put a special absorbent pad or gauze around the G-tube site. This should be changed at least daily or if it becomes wet or soiled.

Do not use any ointments, powders, or sprays around the G-tube unless your nurse says it is OK.

Make sure your child is sitting up either in your arms or in a high chair.

If your child fusses or cries while feeding, pinch the tube with your fingers to stop the feeding until your child is calmer and quiet.

Feeding time is a social, happy time. Make it pleasant and fun. Your child will enjoy gentle talk and play.

Try to keep your child from pulling on the tube.

Since your child is not using their mouth yet, your doctor will discuss with you other ways to allow your child to suck and develop mouth and jaw muscles.

Gather supplies:

• Feeding pump (electronic or battery powered)
• Feeding set that matches the feeding pump (includes a feeding bag, drip chamber, roller clamp, and long tube)
• Extension set, for a Bard Button or MIC-KEY (this connects the button to the long tube on the feeding set)

Your child's nurse will show you the best way to use your system without getting air into the tubes. First:

• Wash your hands well with soap and warm water.
• Check that the formula or food is warm or room temperature.

Next, follow these steps, and any steps your nurse gave you:

• Start with the feeding set, close the roller clamp and fill the feeding bag with food. If a button is being used, connect the extension set to the end of the feeding set.
• Hang the feeding bag high on a hook and squeeze the drip chamber below the bag to fill it at least half way with food.
• Open the roller clamp so that the food fills the long tube, leaving no air in the tube.
• Close the roller clamp.
• Thread the long tube through the feeding pump. Follow the directions on the pump.
• Insert the tip of the long tube into the G-tube and open the clamp. If a button is being used, open the flap and insert the tip of the extension set into the button.
• Open the roller clamp and turn the feeding pump on. Make sure the pump is set to the rate ordered by your nurse.

When the feeding is done, your nurse may recommend that you add water to the bag and let the water flow through the feeding set to rinse it out.

For a G-tube, clamp the tube and close the roller clamp before disconnecting the feeding set from the G-tube. For a button, close the clamp on the feeding set, disconnect the extension set from the button, and close the flap on the button.

The feeding bag should be changed every 24 hours. Food (formula) should not be left in the bag for more than 4 hours. So, only put 4 hours (or less) worth of food in the feeding bag at a time.

All of the equipment can be cleaned with warm, soapy water and hung to dry.

If your child's belly becomes hard or swollen after a feeding, try venting or "burping" the tube or button:

• Attach an empty syringe to the G-tube and unclamp it to allow air to flow out.
• Attach the extension set to the MIC-KEY button and open the tube to the air to release.
• Ask your nurse for a special decompression tube for "burping" the Bard Button.

Sometimes, you need to give medicines to your child through the tube. Follow these guidelines:

• Give the medicines before a feeding so that they work better. You may also be told to give the medicines when your child's stomach is empty.
• The medicine should be liquid, or finely crushed and dissolved in water, so that the tube does not get blocked. Check with your doctor or pharmacist on how to do this.
• Always flush the tube with a little water between medicines. This will make sure that all the medicine goes in the stomach and is not left in the feeding tube.

Contact your child's provider if your child:

• Seems hungry after the feeding
• Has diarrhea after feedings
• Has a hard or swollen belly 1 hour after feedings
• Seems to be in pain
• Has changes in their condition
• Is on new medicine
• Is constipated and passing hard, dry stools

Also call the provider if:

• The feeding tube has come out and you do not know how to replace it.
• There is leakage around the tube or system.
• There is redness or irritation on the skin area around the tube.

Pham AK, McClave SA. Nutritional management. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 6.

Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Nutritional management and enteral intubation. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 19.