Tube Feed, or Not Tube Feed? That Is The Question.

Tube feeding is commonly viewed as a daunting task that may become necessary for a breeder. Here, we aim to demystify tube feeding and build the reader’s confidence in their knowledge surrounding the techniques and importance of tube feeding. To simplify our learning, we will focus on the What, Who, Why, and When tube feeding might be required. Finally, we will walk you through the steps to best perform tube feeding.

What is tube feeding?

Tube feeding is when we use a feeding tube and syringe to deliver milk and hydration to a pup or kitten who is unwilling or unable to suckle. Tube feeding aims to provide much-needed nutrition for weak young to receive their energy requirements. Through this method, we are able to deliver exact amounts into their stomachs, bypassing any need for swallowing. First, of course, you should familiarise yourself with how to do this and feel confident in your knowledge before starting. These steps are available later on.

Who needs tube feeding?

You can tube feed any mammal, but it may not be the most appropriate form of supplement feeding for your pup or kitten. When weighing up your options for supplement feeding your litter, you should consider whether tube feeding is the best option over other methods, such as syringe feeding. In many cases, syringe feeding may be more appropriate for your litter where the mother is unable or unwilling to feed their young. However, if you have one or more puppies or kittens that are unable to suckle and are losing weight, you will need to intervene with tube feeding.

Why might tube feeding be a better choice?

In many cases, the puppy or kitten may be unable to suckle sufficiently, such as for puppies born with cleft palates. In these situations, other feeding supplement styles, such as syringe feeding with a nipple, is unsuitable. Extremely weak neonates may also be unwilling to suckle or lack a suckle reflex, meaning they may not even attempt to feed from the syringe.

When should you start and finish tube feeding?

For many who are new to tube feeding, it may seem a daunting task. However, tube feeding is required from birth if your puppy or kitten refuses to suckle or is physically unable to suckle. Tube feeding will continue until the puppy or kitten regains enough strength to suckle from the mother or a bottle/syringe with a nipple or until they have successfully weaned onto solids at around three to four weeks old.

Now equipped with an understanding of tube feeding, we move on to how to tube feed safely and confidently. Before feeding, we need to take several steps in preparation. We have broken these steps down into two broad stages found below; that is, the Preparation Stage and Delivery Stage.

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Preparation Stage

Acquiring the Appropriate Supplies

Feeding tubes have rounded tips and large lateral holes. These features enable the feeding tube to glide smoothly down the oesophagus into the stomach and allow the milk to escape gently in a lateral direction. It is crucial never to trim a feeding tube, as this would destroy the two main features of the feeding tube. A high-quality, global system for tube feeding is the ENFit System. The feeding tubes and syringes interlock, so they won’t accidentally become disconnected during the feed. It is important to note that they are also only compatible with other ENFit products.

The milk itself is the other component that needs to be acquired and prepared before tube feeding may begin. We recommend a high-quality milk substitute, such as Wombaroo Dog Milk Replacer. This milk substitute must be prepared according to the manufacturer’s instructions and be free from clumps that might block the feeding tube. It is important to note that we do not recommend using a home milk recipe for tube feeding, particularly any that incorporates cow’s milk.

Marking the Feeding Tube

Marking the tube is a step that gives you confidence in the placement of the feeding tube and helps reduce the risk of depositing milk into the lungs. Our recommendation is a combination of two ways of marking the feeding tube. Mark 1 is the length from the lips to the last rib (refer to the image below; right). To measure this length, have the puppy lying on its side in a neutral position, and overlay the feeding tube from the lips/nose to the last rib following the imaginary line of the oesophagus. This length is not a straight line but has some curves to it. This mark represents the maximum 100% insertion of the feeding tube. Make another mark, Mark 2, at 3/4 the length of Mark 1 (thus, representing 75% of maximum insertion. If you have entered the lungs, your tube will stop before Mark 2. This is due to the relative position of the lungs compared to the stomach, where the lungs are further forward. You know the tip of the feeding tube is placed correctly inside the stomach, if Mark 2 has entered the mouth and Mark 1 is close to the lips.

It is important to recognise that as the puppy or kitten grows, these lengths will change, and these measurements require frequent re-assessment (best to do this daily). Remeasuring is paramount to ensure safe tube feeding practices. If the puppy or kitten has grown and you have yet to adjust for this growth, the previous marks will fail to indicate the proper placement of the feeding tube. Without the proper placement, you risk accidentally entering the lungs and aspirating the puppy.

Hygiene and Sterilisation

Generally speaking, feeding equipment does not need to be sterilised as your goal is to deliver milk to the stomach. However, there is a risk of feeding tubes entering the airways, so it is wise to sterilise regardless. Fresh from the packaging, tube feeding equipment will often already be sterilised (ensure you have read the packaging). After use, there are steps required to clean and sterilise the equipment for re-use properly. First, rinse the feeding tube and syringe (inside and out) well in cold water to stop milk from sticking and proteins from hardening. Next, wash the syringe and feeding tube thoroughly in hot soapy water to dissolve the fats of the milk and break down bacterial cell walls. After this, rinse again in hot running water. To sterilise the feeding tube and syringe, soak in a sterilising solution, such as F10 or Milton, for the recommended length of time, then rinse in hot pre-boiled water. Finally, allow to air dry on a clean towel or rack until needed next.

Volume Calculation

The volume calculation will depend on the energy content of the milk substitute you are using and the weight and age of the puppy or kitten. The Resting Energy Requirement (RER) of puppies and kittens changes as they grow. Relative to their size, they will require the most energy per kilogram of weight in their first few weeks of life. Therefore, it is important to ensure that they receive sufficient calories and nutrition through their milk and then food after weaning at around three to four weeks. Generally speaking, depositing a bolus (small rounded mass of milk) of about 1mL per 30 grams of puppy body weight (or 3.4mL/100g) is safe. Next, weigh your puppy in grams, and divide this weight by 30 to determine how much to tube feed your puppy per feed. The frequency of feeding is advised to be around 4 hours, ensuring that the puppy has been toileted and is not showing any signs of discomfort.

Examples: Your puppy is 260 grams after weighing it with good-quality scales. When we divide this weight by 30 (260÷30), we get around 8.5mL. This is the volume of formula we deposit into the stomach for that feed.

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Delivery Stage

We have provided a walkthrough to help break down the individual steps for a successful tube feed. Please ensure that you have read the steps thoroughly and understand them before starting.

Walkthrough

1. Draw up the correct amount of warm milk (using a sampling straw can help reduce mess if desired) and attach it to the marked feeding tube. Push the milk halfway down the feeding tube to minimise the amount of air in the feeding tube.
2. Place the puppy in the feeding position, lying on its front with its head slightly elevated (supported with hand (refer to the image below). Slide the tip of the feeding tube in through the corner of their mouth and backwards along the roof of the mouth to avoid the epiglottis, which leads to the lungs. The puppy may begin swallowing the tube (which is alright).
3. Continue gently passing the tube through the puppy’s mouth until Mark 2 has entered the mouth and you feel it come to a soft stop (just before Mark 1 meets the lips). The feeding tube should now be correctly placed in the stomach. If the puppy vocalises, that is a good sign, as the vocal cords that lie just below the epiglottis are not obstructed (meaning the tube has not entered the windpipe. However, if the puppy coughs OR you stop before Mark 2, you may have entered the lungs. Gently pull t tube back out and try again.
4. Lock the feeding tube in place between your fingers with the hand that is stabilising the head.
5. Hold the syringe facing downward so that any air rises to the top and is not administered.
6. Slowly deliver the pre-calculated amount of formula over 15-30 seconds, allowing the stomach to accommodate gradually.
7. Kink the tube with your fingers and pull it out gently.
8. Check that the puppy’s tummy is nicely rounded and that they are not showing signs of discomfort.
9. Soak cotton wool balls in warm water, and use them to gently stimulate around the genitalia and anus to facilitate toileting (emptying both bowel and bladder).
10. Have a little cuddle, and put them back in their warm and comfy spot to sleep it off.

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Tips and Important Reminders

Safe Hand Grip

The correct hand grip is essential when supplement feeding, as it requires gentle and regular administration. The grip we recommend is achieved by placing your 1st and 2nd fingers around the plunger and securing the flange between your middle and ring fingers when applying pressure on the plug with your thumb. This grip gives you the best flow control for both syringe and tube feeding.

Correct Syringe Size

It is a small thing to note, but using the right syringe size can make the process much easier. There is no one-size-fits-all syringe, so it’s important to look at your needs and what syringe is the best fit. You want the syringe to fit well in your hand and to be able to perform a safe hand grip. If you draw a syringe up to its maximum capacity, it can become harder to grip it safely and make it harder to push down the plunger with your thumb. For milk, 10mL and 20mL syringes work well for neonates.

Control Over Temperature

Never feed a cold animal. The animal must be warm before giving any form of fluid/food. Additionally, the milk or other hydration you are administering must be appropriately warm (36-37ºC). This is to ensure that the fluids you provide will not chill the puppy, leading to poor digestion and more strain on the puppy to bring its temperature back up.

Quality of Milk

We recommend using a milk supplement manufactured for supplement feeding. The milk should also be prepared as per the manufacturer’s instructions and prepared fresh each day (up to 24 hours refrigerated or longer if frozen down). When warming the milk for use, only reheat the required amount. Only reheat milk that is needed, and do not save unused milk that has already been reheated. Reheating milk twice compromises the quality and freshness of the milk and risks making the puppy ill.

Final Thoughts

As with anything, your confidence in tube feeding will come with practice and experience. After reviewing this article, you should understand the background of tube feeding and have a firm understanding of how to perform tube feeding. For a quick reference, ask if we can include a tube feeding pamphlet with your next order of tube feeding supplies.