"Follow the steps below to ensure correct tube placement, and the ongoing safety of the baby is maintained whilst receiving tube feeds. 1.On inserting a new tube verify placement by aspirating gastric contents and test with the pH indicator strips. Correct position is confirmed when the pH reading is less than or equal to 5. Presence of aspirate alone does not guarantee correct placement Note: Some medications, frequent feeds and continuous feeding may alter the pH and/or the colour of the aspirate e.g. acid inhibiting medications. If pH is >5 or there is difficulty in obtaining aspirate, follow the NPSA Decision tree for nasogastric tube placement checks in Children and Infants. The ‘whoosh’ test (injecting air down the tube and listening) is no longer considered safe practice and should not be used to confirm correct tube placement. 2. Record citing of tube, including internal length and pH in the child’s care map and observation chart. 3. Ensure tube remains in correct position by visually checking the tube position, and checking the aspirate with pH strips prior to each bolus feed or administration of any oral medications. This should be recorded in the feeding section of the observation charts. Note: The tube does not need to be fully aspirated prior to each feed, only enough to pH test, or if there is significant abdominal distention from air which needs aspirating. Infants on continuous feeds should have the position of the tube visualised every hour with routine observations, and pH tested every 4 hours with bottle/syringe changes. 4. Secure the tube using duoderm and hypafix tape placed either on the cheek or chin, and ensure this is firmly attached to the tube. 5. Continually assess feeding tolerance. Observe for vomiting, painful and firm abdominal distension, abdominal discolouration, abnormal bowel sounds, blood in stools, haemorrhagic or heavily bile stained (spinach or avocado) gastric aspirate during pH check. Seek medical review if there is any suspicion of feed intolerance. 6. If findings are not reassuring on medical review then feeds should be withheld. Start gastric decompression, consider further investigation and management for suspected NEC, discuss a feeding plan at the next ward round. 7. Ensure infants who are NBM have their gastric tubes on free drainage with the free end of the tube draining into a specimen pot. Do not attach the syringe connected to the gastric tube to the lid of the incubator. For infants on respiratory support, consider aspirating air from the stomach before each feed. 8. Tubes should be routinely replaced every 2 weeks. Note: if the gastric tube is not to be removed this should be recorded clearly on the observation chart and in the clinical notes (e.g. post TOF repair – see surgical guideline)"