Gastrostomy Button Gravity Feeding


The most significant risk with tube feedings is aspiration of feeding into the lungs, be sure the student is positioned properly with head elevated at least 30 degrees


  • Be sure to take steps to ensure patient privacy when performing procedure
  • The most significant risk with tube feedings is aspiration of liquid nutrition into the lungs, be sure the student is positioned properly with head elevated at least 30 degrees
  • Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills


  • Gastrostomy button replacement
  • Adaptor with tubing and clamp
  • Feeding solution in container (bag) at room temperature
  • 60 cc syringe
  • Warm tap water, if prescribed
  • Pole to hold feeding container
  • Student’s Individualized Health Plan (IHP) and/or healthcare provider’s orders


  1. Review healthcare provider’s order including:
    • the type of formula
    • amount
    • infusion type and rate
    • frequency of administration
    • residual volume checks
    • amount of water used to flush the tube
  2. Explain the procedure to child at his/her level of understanding
  3. Wash hands
  4. Assemble equipment and place on a clean surface
  5. Position child either sitting or supine with head up at least 30 degrees
    • The most significant risk with tube feedings is aspiration of liquid nutrition into the lungs, be sure the student is positioned properly with head elevated at least 30 degrees
  6. Put on gloves
  7. Observe abdomen for signs of malposition or obstruction of gastrostomy button such as abdominal distention
    • If student has abdominal distention do not administer feeding and contact parent/guardian and healthcare provider
  8. If residual check is ordered
    • Remove cap or plug from gastrostomy button
    • Attach extension/adaptor tubing
    • Attach 60 mL syringe with plunger to the end of the adaptor tubing
    • Unclamp the tubing and gently draw back on the plunger to remove any liquid or medication that may be left in the stomach (residual)
    • Note the amount withdrawn from tube feeding
    • Return residual to stomach passively (gravity)
    • Clamp the tubing and disconnect the syringe
  9. Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup or syringe
  10. Pour feeding/fluids into feeding container, run feeding through tubing to the tip and clamp tubing
  11. Hang container on pole at height required to deliver prescribed flow
  12. Open safety plug and insert tubing into the adaptor tubing
  13. Open clamp on tubing and adjust flow to prescribed rate
  14. Check rate and flow periodically and adjust if needed
  15. Monitor student during feeding for any signs of intolerance or complications
  16. Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc.
  17. Make feeding like mealtime: allow child to sit with other children during mealtime
  18. When single feeding is completed (bag empty), clamp feeding bag tubing and remove
    • Sometimes a larger volume water flush may be prescribed and will be administered using feeding container and will flush the remainder of the formula through the tubing
  19. Attach syringe and flush adaptor tubing and button with 5ml or prescribed water volume
  20. After flushing, lower syringe below stomach level to facilitate burping
  21. Vent until gassiness is relieved and allow any gastric contents to instill via gravity
  22. Disconnect syringe and extension/adaptor tubing
  23. Plug gastrostomy button
  24. Keep the child in a feeding position (upright) for at least 30 minutes after completing feeding
  25. Wash syringe and tubing with soap and warm water and puts in home container
    • Syringe and feeding extension tubing can be used repeated times for up to 24 hours
  26. Remove glove
  27. Wash hands
  28. Document assessment, interventions, and outcomes in student’s healthcare record
  29. Follow up with parents/guardian and healthcare provider, as needed


Bankhead, R., Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., Metheny, N.A., Mueller, C., Robbins, S., Wessel, J.  (2009).  Monitoring enteral nutrition administration. In: A.S.P.E.N. enteral nutrition practice recommendations.   Journal of Parenteral and  Enteral Nutrition, 33(2), 162-6.

Bowden, V. R., & Greenberg, C. S. (2016). Pediatric nursing procedures (eBook) (4th Edition). Philadelphia: Wolters Kluwer Health.

Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:

Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J.  (1997).  Children and Youth Assisted by Medical Technology in Educational Settings.  Guidelines for Care.  Second Edition.  Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624.

Acknowledgment of Update Reviewer:

Marcy Weidkamp, APNP
Pediatric Gastroenterology
American Family Children’s Hospital

Acknowledgment of Initial Reviewers:

Lori A. Duesing, MSN, RN, CPNP-AC
Advanced Practice Nurse
Department of Gastroenterology
Children’s Hospital of Wisconsin

Kathy Leack, MS, RN, CNS
Advanced Practice Nurse
Children’s Hospital of Wisconsin

Page last reviewed: October 4, 2021
Page last updated: October 4, 2021

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.