Patient Name: ____________________________

Home Guide for the Enteral Tube Feeding Pediatric Patient

Feeding Plan
Tube Type: NG_____ NJ_____ G_____ J______

Formula Name ______________________________________________________

Amount of Formula/Day __________ mL or __________ oz or ___________ cans

Recipe:

Scoops _____________ + _____________ mL water = _______________mL total

Cups _______________ + _____________oz water = _________________oz total

How to provide:

 Bolus

Volume per bolus: ___________________________________________________

Frequency/Times(s): _________________________________________________
Method:  Gravity Syringe  Gravity Bag  Pump at _________________mL/hr

 Continuous

Volume: ___________________________________________________________
Duration/Time(s): ___________________________________________________
Pump at _____________________mL/hr

Type of water:  Tap  Bottled  Boiled and cooled

 Flush(s): _________________________________________________________
Safe Preparation: Wash hands before and after each feeding preparation

1. Wet hands with warm, running water

2. Rub with soap for 15-20 seconds; rinse and dry
3. Prepare feedings on a clean, sanitized surface with clean utensils
*Alcohol-based hand sanitizers and other antiseptics are not effective for the
prevention of foodborne illness

Storage of Human Milk and Powdered Formula

o Refrigerators storing formula should be kept at or below 39 degrees F.

o Prepared or opened formula can be stored safely in the refrigerator for 24 hours
o Blenderized formula can be stored safely in the refrigerator for 24 hours
o Blenderized formula should not sit at room temperature for more than 2 hours

Formula Hang Time Guide

Please note: A can of powdered formula has a 30-day expiration date after
opening. Ready-to-feed formulas expire after 24 hours after opening (keep
refrigerated).
Hang Time
4 hours:
Breast Milk

4 hours for neonates (< 30 days old) and

immunocompromised infants and children

8 Hours:
Powdered Formula
Liquid Formula

*For immunocompromised patients, the medical team may suggest an alternative

hang time: _________ hours

Feeding Bag Storage:

 New bag and tubing set should be used every 24 hours
 Place bag in refrigerator between feedings to prevent bacterial growth