Gaining and Growing: Assuring Nutritional Care of Preterm Infants in the Community

Common Complications of Tube Feeding

This material was taken from Nutrition Interventions for Children with Special Health Care Needs

 Nausea/Vomiting and Diarrhea
 Gastroesophageal Reflux
 Large Residuals
 Tube Feeding Syndrome
 Clogged Feeding Tube
 Leakage of Gastric Contents
 Bleeding Around Stoma
 Infection of Stoma
 Granulation Tissue


Possible Cause(s)


Nausea/Vomiting and Diarrhea

Rapid administration of feeding

  • For continuous drip feeding, return infusion rate to previous tolerated level. Then gradually increase rate
  • For bolus feeding, increase length of time for feeding. Allow for short break during feeding. Offer smaller and more frequent feedings

Hyperosmolar solution

(high calorie and/or high protein formulas)

  • Switch to isotonic formula
  • Dilute current formula to isotonic strength and gradually increase to full strength
  • Check that formula is mixed properly
  • Avoid adding other foods to formula (i.e., baby food, powdered formula)


  • Do not add medication to formula; give between feeding with water or juice (for infants over 6 months CA)
  • Meds that may cause diarrhea include: antibiotics, GI neurologic stimulants beta blockers, laxatives, stool softeners, liquid meds with sorbitol ie. theophyline
  • Review medication profile and change if possible

Air in stomach/intestine

  • Burp child during feedings or allow for short breaks
  • Use medication to decrease gas, ie.simethicone
  • Elevate child's head during feeding and for 30 minutes after meal

Tube migration from stomach to small intestine

  • Pull on tube to reposition against stomach wall

Cold feedings

  • Warm feedings to room temperature

Rapid GI transit

  • Select fiber enriched formula

Bacterial contamination

  • Use breast milk that has been safely collected and stored
  • Refrigerate open cans of formula and keep only as long as manufacturer suggests
  • Clean tops of formula cans before opening
  • Hang only 4 hour amount of formula at a time
  • Be sure feeding sets are cleaned well

Allergy/lactose intolerance

  • Switch to breast milk or lactose-free formula
  • Try soy formula. If allergic to soy, may need elemental or semi-elemental formula

Excessive flavorings

  • Stop using flavorings
  • Decrease fat in formula or use MCT Oil
  • Refer to physician


Inadequate fiber/bulk or fluid

  • Try formula with added fiber
  • Increase water
  • Try supplementing with prune juice
  • Try stool softeners, suppositories, or enema, as indicated
  • Refer to physician

Gastroesophageal reflux

Delayed gastric emptying

  • Refer to physician
  • May recommend medication to stimulate GI tract
  • Elevate child's head (30-45 degree angle) during feeding and for 1 hour after meal
  • Check for residuals before feeding
  • Try smaller, more frequent bolus feedings or continuous drip feeding
  • Consider Jejunal feeding

Large residuals

Decreased gastric motility

  • Elevate child's head during feeding
  • Use gastric stimulant to promote gastric emptying
  • Consider continuous feeds

Hyperosmolar formula

  • Switch to breast milk or isotonic formula


  • Do not add medications to formula; give between feeding with water or juice
  • Refer to physician

Tube feeding syndrome (dehydration, azotemia, and hypernatremia)

Excessive protein intake with inadequate fluid intake

  • Refer to physician
  • Decrease protein
  • Increase fluids. Monitor fluid intake and output


  • Refer to physician
  • Replace sodium losses
  • Restrict fluids

Clogged feeding tube

Residue or coagulated protein

Inadequate flushing of tube


  • Use correct formula
  • Flush tubes with water after giving formula or medication
  • Flush every 3-4 hours with continuous drip feeds
  • Do not mix formula with medication
  • Irrigate with air, using syringe
  • Gently milk tubing
  • Dissolve 1/4 tsp. meat tenderizer in 10 cc water and flush to dissolve clot
  • Replace tube

Leakage of gastric contents

Improper positioning of child

Tube migration

Increased sized of stoma

  • Place child upright for feeding
  • Make sure gastrostomy tube is firmly in place
  • Stabilize tube with gauze pads, adjust crosspiece
  • If stoma is too large for tube, insert new tube
  • Keep skin around stoma clean and dry; use protective ointments and gauze
  • If leaking out of button gastrostomy, may need to replace device
  • Refer to physician

Bleeding around stoma

  • A small amount of bleeding is normal
  • Tape tube securely in place to avoid irritation from movement
  • Secure tube under child's clothing
  • Refer to physician

Infection of stoma

Gastric leakage around tube

Stoma site not kept clean

Allergic reaction to soap

  • Correct cause of leakage
  • Carefully cleanse and protect stoma
  • If stoma site is irritated use plain water or change type of soap used
  • Refer to physician for culture and medication

Granulation tissue

Body rejecting foreign body

Poorly fitting tube causing friction

Use of antiseizure medication such as Dilantin

  • Keep area clean and dry
  • Adjust snugness of PEG tube with crosspiece
  • Stabilize tube using tape, bandnet, ace bandage, tube top
  • Prevent child from pulling on tube
  • Apply silver nitrate as directed by physician


Enteral Feeding Homepage
Gaining and Growing Homepage
More information contact:
Page reviewed: March 24, 2015