1. What Is Tube Feeding?
Tube feeding is a method of feeding babies who are too sick or too preterm to be fed by nipple
(bottle or breast). A feeding tube is inserted into either the baby’s nose or mouth, down the
esophagus, and into the baby’s stomach. Milk (formula or breast milk) is given through this tube.
2. When Are Tube Feedings Necessary?
A. Preterm Babies (,32 to 34 weeks’ gestation)
To be able to be fed successfully by nipple, the baby must be able to coordinate the
Also, the baby must have developed a
• Gag reflex
Preterm babies may be able to do all of these things separately, but babies younger than
32 to 34 weeks’ gestation usually cannot coordinate these activities. If sucking, swallow-
ing, and breathing are uncoordinated, or if the gag reflex is not yet present, a baby may
aspirate milk while trying to feed.
However, many clinicians feel that breastfeeding babies may be put to the breast at
,32 weeks’ gestation as long as they are not requiring respiratory support and have
demonstrated stable vital signs, color, and activity. Fresh breast milk can be valuable in
preventing various illnesses and is less toxic to the lungs than formula if aspirated. Also,
suckling will stimulate the mother’s supply of this important nutrient.
B. Certain Sick Babies (.34 weeks’ gestation)
Certain conditions in babies older than 34 weeks’ gestation will prevent them from being
fed safely by nipple.
• Severe neurologic problems may be associated with an absent gag reflex. Any baby
with an absent gag reflex should not be fed by nipple.
• Severe medical problems, such as sepsis, may make a baby so lethargic that he or she is
unable to eat by nipple. Septic babies also may develop an ileus and may need to be made
npo and given intravenous (IV) fluids until they are stable and bowel sounds are heard.
C. At-Risk Babies Requiring Continuing Care
Babies who were sick and have recovered from their acute illness, but are not yet well,
may need tube feedings. These may include babies who have a gag reflex and are able to
coordinate sucking, swallowing, and breathing, but tire easily from the exertion of nipple
feeding. Tube feedings may be needed to supplement nipple feedings for a baby to receive
D. Babies with Respiratory Distress
Any baby, regardless of gestational age, who either has a respiratory rate greater than
approximately 60 breaths/minute or requires oxygen for acute lung disease should not
receive enteral feeds. These babies should be kept npo and receive only IV fluids for the
ﬁrst several days after birth.
If a baby requires long-term intensive care and is still in mild respiratory distress at several
days of age, cautious tube feedings may be appropriate. If respiratory distress is severe or
prolonged, parenteral nutrition should be provided in a newborn intensive care unit.