Types of feeding and schedules

Just as there are different formula choices for tube feedings, there are also different ways to feed your child. Each child will have their own feeding schedule. It will be developed with your doctor, nurse and dietician. The three types of feedings are:

• Continuous drip feeding – Small amounts of formula are constantly fed throughout the day and/or night. This feeding is given by a feeding pump.
• Bolus feeding – Certain amounts of formula are fed at various times during the day and/or night. A large feeding syringe, a gravity drip bag or a feeding pump can be used to give this feeding. This method is most like the meal and snack routine used by children who eat foods by mouth.
• Combination drip and bolus feeding – Feedings given during the daytime are normally bolus feedings. The rest or extra feedings are given by drip during the night.

You and your child’s health care providers will decide which feeding method is best for your child. They will also help you find a feeding schedule that fits best into your family routine.

Remember to provide sucking and social interaction during feedings.

Giving continuous or drip feedings

Supplies needed

• Formula or liquid food. It can be warmed or room temperature. Store open cans of formula in the refrigerator. Use open cans within 24 hours.
• Feeding bag and feeding pump or gravity feeding system
• Syringe and water for flushing at the end of the feeding. Depending on your child’s age, this will most likely be 5 to 10 mL
• Feeding extension set if your child has a button-type of tube

Steps

1. Gather your supplies. Put them within easy reach.
2. Wash your hands with soap and water.
3. Prime feeding bag and tubing.
4. Tell your child what you will be doing.
5. Position your child with their head elevated. Hold upright at a 45 degree angle. You can have your child sit in a chair, infant seat, high chair or wheelchair, or with the head of the bed up.
6. Attach end of primed feeding bag/tubing to the tube.
7. Unclamp the tube.
8. Turn on the pump. The home care supply company or the home nurse will teach you how to use the home feeding pump.
9. Give the feeding according to instructions from the doctor or dietician.
   If your child cries during the feeding, the feeding will not flow smoothly into the stomach. It is best to stop the feeding, calm your child and then finish the feeding.
10. After the feeding is done, flush the tube with water. Sometimes, if you were told do to so, extra water will be needed at this point.
11. After the water flush is complete, clamp the tube.
12. Disconnect the tubing and secure the tube.
13. Wash supplies with warm soapy water.

Giving bolus feedings

Supplies needed

• Formula or liquid food. It can be warmed or at room temperature. Store open cans of formula in the refrigerator. Use within 24 hours.
• Feeding bag and feeding pump or gravity feeding system or 60 mL syringe.
• Feeding extension set if your child has a button-type of tube.
• Syringe and water for flush at the end of the feeding. Depending on your child’s age, this will most likely be 5 to 10 mL.

Steps

1. Gather your supplies. Put them within easy reach.
2. Wash your hands with soap and water.
3. If you are using a feeding pump, prime the feeding bag and tubing. If you are using a gravity feeding bag, prime tubing for the feeding bag.
4. Tell your child what you will be doing.
5. Position your child with their head elevated. Hold upright at a 45 degree angle. You can have your child sit in a chair, infant seat, high chair or wheelchair, or with the head of the bed up.
6. Attach end of primed tubing or 60 mL syringe without the plunger to the tube.
7. Unclamp the tube.
8. Start by using the method that works easiest to give the bolus feeding. Either pour the formula into the syringe or turn on the pump.
9. Give the feeding as you were told by the doctor or dietician. If your child cries during the feeding, the feeding will not flow smoothly into the stomach. It is best to stop the feeding, calm your child and then finish the feeding.
10. After the feeding is done, flush the tube with water. Sometimes, if you were told do to so, extra water will be needed at this point.
11. After the water flush is done, clamp the tube.
12. Remove the syringe or extension set and secure the tube.
13. Wash supplies with warm soapy water.

Note: Do not plunge (push) the whole feeding. See the sections on how to deal with tube and skin problems to learn what to do for a blocked tube. Call the clinic nurse who works with your child’s doctor if feedings do not flow easily.