Troubleshooting for Enteral Nutrition

It is important for healthcare professionals and parents to be aware of potential signs that an enteral feeding review is required, and methods for overcoming common issues, including when to report these to members of the interdisciplinary team. See Table 17.

Table 17: Indicators for an Enteral Review



Possible Causes

Possible Prevention
and Solutions



  • nasoenteric tube may be misplaced
  • stop the feed
  • seek medical attention


abdominal distension or pain, cramping, nausea, vomiting, diarrhea, retching, or dumping syndrome
  • first feed of the day may be more sensitive due to mucous in the stomach
  • air in the stomach, stomach is too full, or feed is given too quickly
  • tube has moved into a poor position -spoiled formula or dirty equipment
  • acute illness
  • excessive or inadequate feed volumes
  • gut dysmotility including potential influence of medications
  • excessive or inadequate fibre and/or fluids
  • temperature of feed is too cold
  • medication side effects
  • check tube placement
  • consider venting or burping more permanent tubes before during and after feeding
  • administer feeds and flushes more slowly or offer smaller more frequent feedings
  • make and store formula as directed
  • keep feeding sets clean
  • warm the formula
  • have the physician or pharmacist review medications



  • low fluid intake
  • low fibre intake
  • low activity level
  • medication side effects
  • slow movement of intestines
  • increase fluid intake
  • increase fibre intake
  • increase activity level
  • medication review to support bowel movements


unintentional weight loss, excessive weight gains

  • improper preparation of formula leading to excessive or inadequate concentration of formula
  • excessive or inadequate feed volumes
  • change in metabolic demand
  • gastrointestinal complications limiting tolerance and volume administered
  • review feed preparation, mixing, and recipe
  • address gastrointestinal complications to improve tolerance and intake
  • assess volume, concentration and metabolic needs
  • assess feed type or formula selection
  • review potential psychosocial factors

Mechanical Complications

tube blockages

  • less than optimal feed duration or rapid feed administration
  • inadequate water delivery with medications
  • tube positioning
  • inappropriate tube size
  • flush tube before, in between and after giving medication
  • check that the feeding tube is not clamped or bent
  • fill a syringe with 5ml (NG/NJ) or 25ml (g-tube, j-tube) of warm water and gently push and pull on the syringe’s plunger to unblock the tube
  • gently massage the tube using your fingers if the tube remains blocked. 
  • if it can’t be unblocked, seek medical attention.

Tube Site Care

  • redness, granulation tissue, bleeding
  • skin is wet and unclean
  • increased tube movement
  • infection
  • bleeding after tube change or if pulled
  • clean skin more often, expose to air
  • check tube placement and secure as directed by home enteral nutrition program
  • seek medical attention


  • leakage from the tube site
  • Illness
  • Constipation
  • coughing -poor tube fit
  • incorrect tube placement
  • check tube placement and balloon (as applicable)
  • keep skin clean and dry
  • use dressings as directed by nursing or physician
  • set up a bowel routine

(NSW Office of Kids and Families, 2016); (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015)

Refer to:

PEAS Tube Feeding