Feeding Tubes and Dysphagia

Feeding Tubes: What They Are (and What They Are Not)

Few topics in dysphagia management stir up as much emotion, confusion, and clinical debate as feeding tubes. For patients and families, the idea of a feeding tube can feel overwhelming. For clinicians, especially SLPs, the recommendation process can feel ethically and professionally complex.

One thing is clear: feeding tubes should never be recommended simply as a way to “prevent aspiration.” When considering a feeding tube when a patient has aspiration, many factors need to be considered.

Feeding tubes are medical interventions intended to meet nutritional and hydration needs, not a cure for dysphagia. Feeding tubes may be temporary and often patient can continue to eat by mouth with the feeding tube in place.

Let’s unpack what feeding tubes are, when they may be appropriate, and the important role (and limits) of the SLP in these decisions.

What Is a Feeding Tube?

A feeding tube is a form of enteral nutrition, meaning nutrients are delivered directly into the gastrointestinal tract when oral intake is insufficient, unsafe, or not possible.

Common types include:

Nasogastric (NG) tubes – short-term use, inserted through the nose into the stomach
Gastrostomy tubes (PEG or G-tubes) – longer-term access placed directly into the stomach
Jejunostomy tubes (J-tubes) – placed into the small intestine, often for patients with gastric issues

These tubes bypass the oral phase of swallowing but do not eliminate aspiration risk, particularly aspiration of saliva, reflux, or secretions.

Why Feeding Tubes Are Recommended

The primary indication for a feeding tube is inadequate nutrition and hydration.

Feeding tubes may be considered when a patient:

Cannot meet caloric or fluid needs orally
Is experiencing unintentional weight loss or malnutrition
Has prolonged inability to eat safely enough to sustain life
Requires nutrition support during medical recovery (e.g., post-stroke, cancer treatment, prolonged intubation)
Has increased metabolic demands that exceed oral intake capacity

These decisions are typically driven by medical, nutritional, and metabolic factors, not swallowing impairment alone.

The Aspiration Myth: Feeding Tubes Do Not “Prevent” Aspiration

One of the most persistent misconceptions in healthcare is that feeding tubes prevent aspiration pneumonia.

They do not.

Aspiration can still occur due to:

Oral secretions
Saliva
Refluxed tube feeds
Poor oral hygiene
Reduced mobility or altered mental status

Research has repeatedly shown that tube feeding does not eliminate aspiration pneumonia risk and, in some populations, may not reduce it at all.

This is why recommending a feeding tube solely because a patient aspirates is not evidence-based.

From the research:

“After tube placement several patients developed aspiration pneumonia for the first time and many with a history of aspiration continued to aspirate.” Finucane and Bynum 1996.

“Short-term tube feeding, however, may be indicated in elderly patients with severe dysphagia and aspiration in whom improvement of swallowing is likely to occur.” Marik and Kaplan 2003

The SLP’s Role in Feeding Tube Decisions

This is a crucial distinction for clinicians to understand and communicate clearly.

SLPs can:

Identify dysphagia and swallowing physiology impairments
Assess aspiration risk and airway protection
Recommend alternative means of nutrition when oral intake is insufficient or unsafe
Educate patients, families, and teams about swallowing-related risks and benefits
Advocate for patient-centered, informed decision-making

SLPs cannot:

Order a feeding tube
State that a patient must receive a feeding tube

The decision to place a feeding tube is a medical decision, typically involving the physician, dietitian, patient, and family, ideally with interdisciplinary collaboration.

Our language matters. Phrases like “the patient needs a PEG” overstep our scope and can unintentionally remove patient autonomy from the conversation.

Ethical and Patient-Centered Considerations

Feeding tube decisions are rarely just clinical but they are deeply personal.

Patients may choose to:

Accept a feeding tube
Decline a feeding tube
Use a feeding tube temporarily
Continue oral intake despite known risks

All of these choices are valid when patients are informed, capable, and supported.

As SLPs, our role is not to persuade, but to inform, clarify, and support.

Ultimately, the decision of a feeding tube belongs to the patient, family and caregivers.

Feeding Tubes and Dysphagia Therapy Can Coexist

Importantly, the presence of a feeding tube does not mean swallowing therapy stops.

Many patients:

Receive temporary tube feeding while participating in dysphagia rehabilitation
Use a feeding tube to supplement nutrition while continuing pleasure feeds
Transition off tube feeding as swallow function improves

Feeding tubes can be a bridge, not a destination.

Things to Consider in Home Health and the Community

The formula prescribed for the patient, may just not be for them. If they are experiencing side effects, they may need to talk to their doctor and a dietitian for any changes.

Keep a can of Coke handy because this can help to unclog a feeding tube.

If the patient stops using the feeding tube, they will need to continue to flush the tube with water at least once daily until it can be removed.

The tube will almost always fall out if left in long enough. The tube is held in with an inflatable balloon, which usually deflates as it is constantly exposed to stomach acid. If the tube falls out, they will need to go to the ER to have a new tube placed.

Key Takeaways for Clinicians

Feeding tubes are recommended based on nutrition and hydration needs, not aspiration alone
Feeding tubes do not eliminate aspiration risk
SLPs may recommend alternative nutrition but cannot mandate tube placement
Patient autonomy and informed consent are central to ethical care
Dysphagia therapy and tube feeding are not mutually exclusive

Feeding tubes are powerful medical tools, but like all tools, they must be used for the right reasons, with the right expectations, and with respect for patient choice.

As SLPs, our responsibility is to bring clarity, evidence, and compassion to one of the most challenging conversations in dysphagia management.

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References:

Crary, M. A., & Groher, M. E. (2006). Reinstituting oral feeding in tube‐fed adult patients with dysphagia. Nutrition in Clinical Practice, 21(6), 576-586.

Finucane, T. E., & Bynum, J. P. (1996). Use of tube feeding to prevent aspiration pneumonia. The Lancet, 348(9039), 1421-1424.

Marik, P. E., & Kaplan, D. (2003). Aspiration pneumonia and dysphagia in the elderly. Chest, 124(1), 328-336.

Wilmskoetter, J., Bonilha, L., Martin-Harris, B., Elm, J. J., Horn, J., & Bonilha, H. S. (2019). Factors influencing oral intake improvement and feeding tube dependency in patients with poststroke dysphagia. Journal of Stroke and Cerebrovascular Diseases, 28(6), 1421-1430.

Vesey, S. (2013). Dysphagia and quality of life. British journal of community nursing, 18(Sup5), S14-S19.