How to Give Bolus Feedings Through a Feeding Tube

What is bolus feeding?

Bolus feeding is a way to give enteral nutrition (tube feeding). Bolus feedings give large doses of formula several times a day. The formula is poured slowly into a syringe attached to a feeding tube or button.

Your care team will decide on best way to give your child tube feedings. Other ways to give tube feedings include continuous feeding and gravity feeding.

Always follow the instructions given by your care team.

Prepare the formula

Your care team will choose the best formula for your child’s nutritional needs.

Most formula comes ready to feed. It is in a can that you open and pour directly into a measuring container or a formula bag that goes with your child’s feeding tube. Some formula comes in a powder or liquid concentrate you mix with water. Your care team will tell you how to mix the formula, if needed.

Formula that has been opened or mixed can be stored in the refrigerator for 24 hours. Throw away any unused formula after 24 hours.

Your dietitian will tell you how much and how often to give the formula. You will need to know:

• Type of formula
• Number of milliliters (mL to give each feeding
• How often (usually every 3-4 hours)

The formula should be at room temperature. If you keep it in the refrigerator, take it out about 1 hour before feeding time. Pour enough formula for 1 feeding into a clean container. Cover it and let it warm up to room temperature on the counter. Put any extra formula back in the refrigerator. Throw out any canned or mixed formula that has been open more than 24 hours.

Gather supplies in a clean work area

Supplies for bolus feedings include:

• Amount of formula for 1 feeding, room temperature
• Water (mL)
• Syringe (at least a 35 mL syringe)
• Feeding adapter tube (only if your child has a button)

Attach the feeding adapter (if your child has a button)

• Wash your hands with soap and water.
• Fill the adapter with water and clamp.
• Pull the cover back from the button.
• Insert the tip of the adapter into the small hole in the middle of the button. Make sure the lines on the adapter line up with the lines on the button.
• Gently push in the adapter as far as it can go and twist to lock.

The first time you attach the adapter it might be tight and hard to push in, and it may be uncomfortable for your child. However, it should not hurt after the skin has healed completely.

Position your child sitting up

Make sure your child is sitting up for feedings so that their head is higher than their stomach. You can hold a small child on your lap or have them sit in a highchair. If your child is older, have them sit in a chair or highchair or raise the head of the bed 30–45 degrees. You can put pillows behind your child’s head to help them sit up in bed.

Give the feeding

• Take the plunger out of the syringe.
• Take the plug out of the opening of the feeding tube or adapter tube.
• Attach the tip of the syringe to the tube.
• Hold the syringe upright (tip facing down) and slightly above your child’s stomach.
• Unclamp the feeding tube or adapter.
• Put the recommended amount of water into the syringe.
• Slowly pour the recommended amount of formula into the syringe. Let it drain into the tube by itself (by gravity). Do not push the formula into the tube.

• When all the formula has gone in, pour the recommended amount of water in the syringe to rinse the tube.
• Clamp or plug the tube after the water has gone through.
• Disconnect the syringe from the tube.
• Remove the adapter tube, if needed.
• Wash your hands again with soap and water or use an alcohol-based hand sanitizer.
• Wash the syringe (and adapter if you used one) with warm water and dishwashing soap. Rinse them and let them air dry between feedings.

Keep your child's head higher than their stomach for 1 hour after the feeding.

Watch your child for any signs of nausea, vomiting, stomach swelling, pain, or being irritable (cranky or fussy) during the feeding and right after. If any of these things happen, stop the feeding, and call your care team.

Tips for giving bolus feedings

• If your child fusses or cries during a bolus feeding, pinch the tube with your fingers or lower the syringe to slow or stop the feeding until your child is calmer and quieter. Feedings often will not infuse while your child is fussing or crying.
• You can make the formula go in faster or slower by raising or lowering the syringe. The higher above your child’s stomach you hold the syringe, the faster the formula will go into your child’s stomach.
• Never use the plunger of the syringe to force the formula into the tube. If the formula will not go in, you may put gentle pressure on the formula with the syringe plunger.
• Do not let the syringe get completely empty during the feeding. Air can get into your child’s stomach through an empty syringe. This can puff up your child’s stomach and cause discomfort.
• Flush the feeding tube with the recommended amount of water before and after each feeding.
• Clean the syringe and adapter thoroughly between feedings. You may use the syringe and adapter for up to 2 weeks. Throw them out sooner if you cannot get them completely clean.

Talk to your care team if you have any questions about tube feedings.