Nasojejunal (NJ) tube: Caring for your child at home

What is a nasojejunal tube?  

A nasojejunal (NJ) tube is a long, hollow tube that is passed through a nostril, past the stomach and down into your child’s small intestine. The end of the NJ tube sits in a part of the small intestine called the jejunum. NJ tubes are inserted under image guidance in hospital. They cannot be inserted at home. 

Why does my child need an NJ tube? 

Your child may need an NJ tube because they do not tolerate being fed into their stomach. Talk to a member of your child’s health-care team to understand the reason your child has this tube. 

How often do NJ tubes need to be changed? 

NJ tubes are routinely changed every month. The tube will also be changed as needed if it is accidently removed or cannot be unblocked. Speak to a member of your child’s health-care team to confirm when your child will be seen in hospital for a routine NJ tube change. 

How are NJ tubes secured? 

NJ tubes are secured with tape on your child’s cheek. The tape should be clean and dry. It is important to replace the tape if it gets wet, dirty or is lifting off your child’s face. You can replace the tape at home if needed. Make sure to carefully hold the NJ tube in place to stop it from moving in or out of your child’s nostril.  

If your child has very sensitive skin or frequently pulls at their NJ tube, it may be secured with a device called a nasal bridle. Talk to your child’s health-care team to learn more about a nasal bridle. 

How do I prevent skin issues around my child’s nose when they have an NJ tube? 

When your child has a tube in their nose, it is important to keep the skin around the tube clean, dry, and free of nasal mucous. Clean the skin around the NJ tube and wipe away any nasal mucous at least once a day using soap and water, then dry. If you have concerns about your child’s skin, speak with a member of the health-care team.  

Your child’s health-care provider will try to insert the NJ tube in alternating nostrils each month to avoid skin irritation on one side of the nose.   

Checking NJ tube placement 

When to check NJ tube placement  

Check that the NJ tube placement is correct:  

• before each use, including before giving formula, fluids or medications 
• every four hours during a continuous feed  

How to check NJ tube placement 

1. Using a measuring tape, measure the length in centimetres of the NJ tube from your child’s nostril to the end of the yellow tube, as shown below. The measurement should be the same each time. 

2. Compare this measurement to the length recorded when the tube was first placed. Ask your child’s health-care provider for this length if you do not know and make a note of the length: 
• The external length of my child’s NJ tube is ____ centimetres.  
3. If the external length has changed, do not use your child’s NJ tube. If your child is receiving a feed, stop the feeding pump. A change in length may mean the tube is not in the intestine, which would make it unsafe to feed your child through the tube. Contact a member of your child’s health-care team or bring your child to the hospital to have the tube’s placement checked.  

Feeding your child through the NJ tube 

Continuous feeding with NJ tubes  

An NJ tube delivers formula past your child’s stomach and directly into their intestine. The intestines receive food slowly and steadily, so formula must also be given at a slow, steady pace. This is why children who are fed with NJ tubes are fed small volumes over a long period of time using a feeding pump (e.g. 15 mL of formula each hour for 15 hours). This is called continuous feeding and is the safest option when using NJ tubes.  

Do not give large amounts (also known as boluses) of formula or fluids through the NJ tube at once. Speak with a member of your child’s care team or a dietitian to review your child’s feeding plan.  

How to feed your child through the NJ tube 

1. Gather the following equipment:  
• measuring tape  
• formula 
• feeding bag and tubing 
• feeding pump 
• syringe 
• water to flush NJ tube  
• IV pole (or a similar item to hang the feeding bag from)  
2. Wash your hands.  
3. Check the NJ tube placement by measuring the length, as described above.   
4. Fill the feeding bag and tubing with formula.  
1. Pour the formula into the feeding bag, close the seal tightly, and hang the bag higher than the feeding pump. Do not warm the formula that will be fed continuously though your child’s NJ tube.  
2. Let the formula flow to the end of the tubing. This is called priming the tubing. The tubing should not be connected to your child’s NJ tube at this step. 
3. Depending on the feeding pump you use, priming the tubing can be done manually or using the feeding pump. Refer to feeding pump instructions. 
5. Install the feeding tubing into the feeding pump. 
6. Program the pump with how much formula to give (volume in milliliters) and how fast (rate in milliliters per hour, or mL/hr) as instructed by your child’s health-care team. 
7. Attach a feeding syringe to the NJ tube with 5-10 mL water or with a volume of water as recommended by your child's health-care team. Then, push the end of the syringe to flush the NJ tube. 
8. Connect the feeding tubing to your child’s NJ tube.  
9. Start the feeding pump.  
10. Every four hours during a continuous feed: 
1. Check the NJ tube placement by measuring the external length. 
2. Pause the feeding pump and flush the NJ tube with 5-10 mL of water to prevent blockages. Then, restart the feeding pump.  
11. Refill the feeding bag with formula as directed by your child’s health-care team.  
• Once formula is poured into the feeding bag, it can only be used safely for a limited amount of time. For example, if using ready-to-feed formula, only pour enough formula into the feeding bag to last for eight hours of continuous feeding. This helps reduce the risk of bacteria growing in the formula. 
12. When the continuous feed is done, turn off the feeding pump and disconnect the tubing from the NJ tube.  
13. Attach a feeding syringe to the NJ tube with 5-10mL of water or with the volume of water your child's health-care team has recommended. Then, push the end of the syringe to flush the NJ tube. 
14. Close the end of the NJ tube.  

Monitoring your child during pump feeds  

Make sure the NJ tube stays in place during the feed. It is also important that your child does not catch the tubing on anything or trip over it if they are moving around during a feed. Talk to your child’s health-care team about ongoing or increased observation while your child is feeding using an NJ tube and feeding pump. Children who cannot tell you whether their tube has moved or that they are in discomfort may need increased observation.  

Can I give my child medications through the NJ tube?  

Speak to your child’s health-care team to understand if your child can tolerate oral medications by mouth or if they need to be given their medicine through the NJ tube. 

Caring for the NJ tube 

Cleaning your equipment  

• Speak with your child’s health-care provider about recommendations for rinsing the feeding bag and tubing during a continuous feed. 
• When the continuous feed is done, clean the bag and tubing with warm soapy water. To rinse well, let the water flow through the tubing and into the sink. Allow the bag and tubing to air dry. 
• Take apart the syringes and wash the syringes with warm soapy water after each use. Rinse well with warm, clear water and let air dry.  
• Replace feeding bag/tubing and syringes every seven days.  
• Feeding bag/tubing and syringes can be discarded in regular garbage bins. 
• Follow the feeding pump instructions on how to clean the feeding pump.   

When to flush the NJ tube 

Flushing the NJ tube prevents it from becoming blocked. Flush the NJ tube with 5-10mL of water: 

• every four hours during a continuous feed 
• at the start and end of a continuous feed 
• before and after every medication  

You should be able to flush the NJ tube easily with water. If you feel resistance when flushing, the tube may be blocked. To unblock the tube: 

1. Fill a small feeding syringe (e.g. 1 mL) with warm water.  
2. Attach the syringe to the end of the NJ tube and apply a push-pull motion on the syringe plunger to unblock the tube.  
3. If you are unable to unblock the tube, speak with a member of your child’s health-care team or seek medical attention.  

How do I know when my child no longer needs the NJ tube? 

Speak with your child’s health-care team to understand when your child no longer needs the NJ tube.  

When it is confirmed that your child no longer needs the NJ tube, the tube can be removed at home by following the steps below:  

1. Wash your hands.  
2. Remove the tape from your child’s face that is securing the NJ tube. 
3. Hold the tube using your thumb and index finger, then pull it out gently.  
4. Once the tube is out completely, inspect the part of the tube that was inside your child’s body for any breakages. If you notice any breakages, bring your child to the emergency department for a physical exam. Bring the broken tube with you as well.  
5. If no breakages are seen, throw the NJ tube in the garbage.  

If the external length has changed 

If the external length of the NJ tube has changed, do not use your child’s NJ tube. The placement of the NJ tube will need to be confirmed using imaging at the hospital. 

If the NJ has moved into the stomach 

It is possible for the end of the NJ tube to move from the small intestine into the stomach. If this happens, the appearance of the NJ tube from the outside may look the same but your child may experience:  

• new vomiting or vomiting formula  
• gagging or retching  
• belly discomfort or pain  
• bloated stomach  

If you suspect the NJ tube has moved into your child’s stomach, stop using the tube. Bring your child to the hospital to confirm the placement of the NJ tube.  

Tube-related intussusception 

Intussusception is when one part of the small intestine slides into the next part like a telescope. This prevents the passage of anything through the intestine and causes pain. Intussusception may occur around the end of the NJ tube. 

A child with intussusception may experience: 

• belly pain (e.g. your child brings their knees to their chest) 
• bloated belly 
• dark green vomit (bile) 
• irritability 
• feeding intolerance (increased reflux, vomiting, gagging or retching) 
• blood and/or jelly-like stool  
• diarrhea  
• fever 

If your child has any of these symptoms, stop using the NJ tube and take your child to the Emergency Department immediately for a physical exam.  

Amika Feeding Pump e-Training Module: https://filecard.de/kpunkt/fresenius/amika-e-learning/#/ 

Moog Medical - Enteral Resource Center: https://www.moogmedical.com/enteral/resources/ 

Cardinal Health Kangaroo OMNI: https://caflipbookdigitallibrary.cardinalhealth.ca/view/506936696/ 

AMT BridlePro Nasal Tube Retaining System: https://www.appliedmedical.net/wp-content/uploads/2026/02/Bridle_OS_C-3802-S.pdf