✅ Preparation: 

1. Wash your hands thoroughly with soap and water or use hand sanitizer. 

2. Prepare skin protection: 

• Cut a piece of DuoDERM®, Tegaderm®, or hypoallergenic tape large enough to secure the tube and protect your child’s cheek from irritation. 

• Apply it to the cheek where the tube will rest. 

3. Measure the correct length for insertion: 

• Measure from the tip of the nose (A) → to the earlobe (B) → to the midpoint between the xiphoid (bottom of the breastbone) and the umbilicus (belly button) (C). 

• Mark this point (C) on the tube with a permanent marker or a small piece of tape—this is your insertion depth. 

4. Position the child: 

• Infants: Swaddle and lay them on their back with the head in a neutral position. 

• Older children: Sit upright with head in a neutral or slightly flexed position to ease passage of the tube. 

1. Lubricate the tip of the tube with water-soluble lubricant (Do NOT use Vaseline® or oil-based products). 

2. Gently insert the tube into the selected nostril and aim straight back toward the ear, not upward. 

3. Advance the tube slowly and steadily: 

• If resistance is felt, stop. Do not force. 

• Gently withdraw and reposition or re-lubricate if necessary. 

4. Encourage swallowing (if age-appropriate) by: 

• Offering small sips of water or using a straw for older children. 

• Providing a pacifier or allowing sucking for infants to help guide the tube. 

5. Continue inserting the tube until your mark is at the nostril. 

• Attach the tube to the prepared DuoDERM®/Tegaderm® base on the cheek. 

• Add an additional piece of tape across the tube for securement. 

• Avoid pulling tension on the tube to prevent pressure sores. 

• Best Practice: Confirm NG tube placement with pH testing of aspirate (pH <5 suggests gastric placement). 

• If unable to aspirate:  

1. Check for air bolus sound over the stomach (less reliable). 

2. X-ray confirmation is the gold standard for initial placement in clinical settings or if in doubt. 

• Never force the tube if resistance is met. 

• Stop if the child has persistent coughing, gagging, or shows signs of distress—tube may be in the airway. 

• Always confirm tube position before every feed or medication administration.