Constipation — meaning difficult-to-pass and very infrequent bowel movements — can sometimes happen when your child is tube-fed. During tube-feeding, bowel movements may be less frequent than usual. If your child is constipated, he or she may feel uncomfortable or bloated.

• Not enough water is being given
• No fiber, or not enough fiber, in the formula
• Unable to get enough physical activity
• Medications

• Provide additional water flushes through the feeding tube as instructed by your healthcare professional.
• Check with your doctor or dietitian to see if your child should change to a formula that contains fiber, or if you should add a fiber supplement.
• If it is permitted, and your child is able, increase your child's physical activity.
• Ask your healthcare professional to review your child's medications to see if any may cause constipation.

Diarrhea — frequent loose and watery stools — can sometimes happen when your child is tube-fed. A child who is tube-fed may normally have more frequent or watery stools, but if they are having four or more loose or watery stools a day, speak with your child's doctor.

• Medications
• Formula is too cold
• Rate of feeding is too fast
• Formula may have been spoiled or contaminated by bacteria after opening
• No fiber, or not enough fiber, in the formula
• Intolerance to the formula

• Because emotions can affect digestion, help your child to relax during the feeding.
• Do not refrigerate unopened cans or containers of formula.
• Remove opened cans or containers of formula from the refrigerator at least 30 minutes prior to feeding, allowing the formula to warm to room temperature.
• Contact your child's healthcare provider for advice on slowing the feeding rate.
• Do not use formula that has been opened and left at room temperature for longer than the manufacturer's recommendation.
• Do not use formula that has been opened and left in the refrigerator for longer than 24 hours.
• Check with your healthcare professional about changing to a formula that contains fiber, or adding a fiber supplement.
• Check with your healthcare professional to see if your child should change to a special formula that contains ingredients that are easier to digest.
• Wash your hands thoroughly, and disinfect the top of the formula can or container with an alcohol wipe, before you open the can or container or handle the formula and tubing.
• Replace the feeding container and tubing as directed by your healthcare professional.

• Formula is being fed too fast
• Formula is too cold
• Too much formula at one feeding
• Lying flat while taking the feeding
• Engaging in too much activity right after a feeding
• Intolerance to the formula

• Consult your child's healthcare provider for advice on slowing the rate of feeding.
• Do not refrigerate unopened cans or containers of formula.
• Remove opened cans or containers of formula from the refrigerator at least 30 minutes prior to feeding, allowing the formula to warm to room temperature.
• Make sure you are following the directions for the prescribed amount of formula and/or correct flow rate.
• Do not allow your child to lie flat during or just after a feeding. Your child should sit or lie at a 45-degree angle during the feeding and for an hour after the feeding.
• If directed by your child's doctor, check the residuals in your child's stomach before restarting the next feeding.
• Ask your child's doctor or dietitian to reevaluate your child's formula. You may need to switch to a formula that has more calories in less volume or to a special formula that contains ingredients that are easier to digest and absorb.

Your child may be receiving too little fluid or losing too much fluid. Some potential early signs of dehydration include thirst and urine that is darker yellow than usual. More serious signs could include dryness of lips, tongue and skin, and decreased urine output.

• Formula is too concentrated (which means it contains too little water)
• Frequent diarrhea
• Prolonged fever
• Not taking enough water
• A wound is draining large amounts of fluid
• Sweating heavily

• Give your child the prescribed amount of water every day before and after their feedings.
• If your child is experiencing fever, diarrhea, excessive wound drainage or heavy sweating, consult your child's doctor to determine how much more water you need.

Aspiration refers to formula that enters the lungs, and usually causes coughing, gagging and difficulty breathing. Consult your child's doctor immediately if symptoms develop.

• Formula has backed up or been inhaled into your child's lungs
• Lying flat during feeding

• Check that the tube is properly positioned.
• Have your child sit or lie at a 30–45 degree angle (about the height of two pillows) during the feeding.
• Have your child remain sitting up for at least one hour after the feeding.
• If your child is taking their feeding at night, follow the doctor's instructions for elevating the head of the bed.
• If your child feels or looks bloated, is irritable, looks uncomfortable or has been vomiting, do not begin a feeding. Consult your child's doctor immediately if symptoms develop.
• If directed by your child's doctor, check the residuals in your child's stomach before restarting the next feeding.

Formula is not flowing smoothly through the tube.

• Kink or bend in the feeding tube
• Dried formula or medication is blocking the feeding tube

• Check to make sure there are no kinks or bends in the feeding tube.
• Flush the tube before and after each feeding with water (ask your child's doctor how much water should be used for each flush).
• When giving medications, dissolve them thoroughly in warm water before administering them through the feeding tube.
• Flush the tube with room temperature water before and after administering medications.
• If the tube is blocked, do not try to remove the blockage yourself. Consult with your child's doctor for directions on what to do.