Returning to Eating After Feeding-Tube Use

This page is for people moving from tube feeding back to eating by mouth, and for the family helping them. It explains swallow tests, food textures, daily meal rules, exercises, and the warning signs to watch for.

A feeding tube delivers liquid nutrition straight into the stomach or the small intestine. In cancer care it is used when you cannot eat or digest enough food to stay nourished. Staying nourished raises the chance of getting through treatment without unplanned breaks.

The type of tube says something about the plan. A nasogastric tube goes through the nose and down the throat. It is used when support is needed for only a few weeks. A gastrostomy tube, often called a G-tube or PEG, sits in the stomach through a small opening in the belly. A jejunostomy tube goes into the small intestine and is usually used for longer-term feeding.

Treatment itself can affect swallowing. NCI says radiation to the head and neck may make it hard to chew and swallow safely. NCI also says some chemotherapy and immunotherapy can harm cells in the mouth, throat, and lips.

The National Cancer Institute is direct on this point: "Some people can still eat by mouth when using enteral nutrition. Before doing so, it is important to ask your doctor if it is safe for you."

A speech-language pathologist, or SLP, is the swallowing therapist who can help answer that, along with your doctor.

Teams often use one of two tests that look inside.

• A modified barium swallow study, sometimes called videofluoroscopy. You eat and drink small amounts mixed with barium, a liquid that shows up on X-ray. The X-ray runs as a video, so the team can see where food goes and where it gets stuck.
• A fiberoptic endoscopic evaluation of swallowing, or FEES. A thin tube with a camera and a light goes through the nose to the back of the throat. The SLP watches you swallow real food.

Ask which one you are getting and ask to see the pictures.

Aspiration means food or fluid goes into the airway instead of the food pipe. It can lead to pneumonia. This is the reason the diet is stepped up slowly rather than all at once.

MedlinePlus lists these signs of swallowing problems: coughing or choking during or after eating, gurgling sounds from the throat, throat clearing after drinking, and coughing food back up. Some people aspirate without coughing at all. That is called silent aspiration. The video X-ray and FEES tests described above can show it, which is one reason teams use them.

Many teams describe food and drink using a shared scale called the IDDSI framework, from the International Dysphagia Diet Standardisation Initiative. It has eight levels numbered 0 to 7. Drinks use levels 0 to 4 and foods use levels 3 to 7. Level 0 is thin drinks and level 7 is regular food. The levels in between add more change in texture. The point of the scale is that "soft diet" means the same thing in the hospital, the rehab unit, and your kitchen.

Ask for your level in writing, for both drinks and food. Ask what has to happen before you move up one level, and who decides.

For the softer end of the range, the National Cancer Institute lists several options. They include scrambled or soft-boiled eggs, cottage cheese, macaroni and cheese, mashed potatoes, cooked cereals like Cream of Wheat or grits, creamy peanut butter, soups and stews, pureed cooked foods, and salads made with chicken, egg, or tuna. For desserts and snacks: yogurt, pudding, custard, flan, applesauce, bananas, ice cream, sherbet, sorbet, gelatin, milkshakes, and smoothies. If calories are short, instant breakfast drinks and liquid supplements can fill the gap.

Two practical tricks from NCI: soften dry foods with gravy, sauce, or other liquid, and use a blender to make food easier to swallow.

These come from MedlinePlus, the patient library run by the National Library of Medicine.

• Sit up as straight as you can while eating.
• Stay sitting upright for 30 to 45 minutes after you finish.
• Take small bites, under 1 teaspoon of food at a time.
• Chew well and swallow before taking another bite.
• Do not mix solid food and liquid in the same mouthful.
• Do not wash solids down with a sip of liquid unless your therapist says that is fine for you.
• Do not drink thin liquids until your provider or therapist clears them.
• Do not talk and swallow at the same time.
• If one side of your face is weak, chew on the stronger side.
• Keep meals unhurried.

In one study of 85 people having radiation or chemoradiation for head and neck cancer, those who did at least one full set of swallow exercises a day did better than those who did not. A month after treatment, 54.4 percent of the exercise group were eating a regular chewable diet, against 21.4 percent of the other group. Also, 22.8 percent of the exercise group still depended on a feeding tube, against 53.6 percent of the other group.

This was a review of records at one center, not a randomized trial. It cannot prove that the exercises caused the difference. The program asked for three sets a day. The exercises included effortful swallows, gargling, tongue exercises, the Mendelsohn maneuver, and Shaker head lifts. A speech-language pathologist taught them and checked in weekly. Ask your own team for a written set, and ask how often to do them.

Ask your care team what has to happen before the tube comes out, and who decides. Weigh yourself on the same scale, at the same time of day, and write it down. Bring the log to appointments. MedlinePlus says to contact your provider if you are losing weight.

While the tube is still in, keep the site clean. MedlinePlus says to clean the skin around a feeding tube one to three times a day with mild soap and water. It also says to flush the tube at the end of a feeding and after medicine, so it does not clog. Follow the steps your nurse gave you.

Call 911 or go to an emergency department if:

• You choke during or after eating or drinking, or food or drink will not clear from your airway.
• You have real trouble breathing, are gasping, or your lips or face turn blue or grey.
• You cough or vomit blood.
• A fever comes with breathlessness, chest pain, shaking chills, confusion, or a racing pulse. MedlinePlus lists fever, chest pain, shortness of breath, and confusion among the signs of aspiration pneumonia.
• Bleeding at the tube site is heavy or will not stop.

Call your cancer team right away, day or night, if:

• You are having chemotherapy and your temperature is 100.4°F (38°C) or higher. CDC says to call your doctor right away for this. If you go to the emergency department, tell the staff you are on chemotherapy. If you cannot reach your team, go to the emergency department.
• You are on chemotherapy, have had a stem cell transplant or CAR T therapy, or have low white blood cells, and you have chills, a sore throat, mouth sores, burning when you pass urine, or any other sign of infection. A normal temperature is not a reason to wait.
• You have a cough with fever, or shortness of breath, after eating by mouth. MedlinePlus lists fever and shortness of breath among the aspiration pneumonia signs to contact your provider, go to the emergency room, or call 911 for; if breathing is hard, call 911.
• You develop a new cough, or bring up phlegm, after you start eating by mouth.
• The feeding tube is pulled out, leaks, or will not unclog.
• There is redness, swelling, an odor, pus, or bleeding at the tube site, or you are vomiting or your stomach is bloated. MedlinePlus says to contact your provider right away for these tube problems.

Call your cancer team the same day if:

• You are losing weight.
• Swallowing is getting harder rather than easier.
• Pain in your mouth, lips, or throat makes it hard to eat, drink, or sleep.

Do not wait out a cough after a meal. Say on the phone that you have been eating by mouth again after tube feeding. If you are on chemotherapy, call right away, day or night, for any item in the same-day list above as well.

It is worth learning what to do if someone chokes before you need it. Ask your speech-language pathologist or the tube-feeding nurse to show a family member what to do.

• Nutrition in Cancer Care (PDQ) Patient Version — National Cancer Institute
• Easy-to-Chew and Easy-to-Swallow Foods — National Cancer Institute
• Mouth and Throat Problems and Cancer Treatment — National Cancer Institute
• Swallowing problems — MedlinePlus, National Library of Medicine
• Aspiration pneumonia — MedlinePlus, National Library of Medicine
• Jejunostomy feeding tube — MedlinePlus, National Library of Medicine
• Swallow Preservation Exercises during Chemoradiation Therapy Maintains Swallow Function — PubMed Central, National Library of Medicine
• Fever and Cancer Treatment — CDC
• Signs and Symptoms of Infection During Chemotherapy — CDC
• Dysphagia Tests — MedlinePlus, National Library of Medicine
• Bleeding — MedlinePlus, National Library of Medicine
• IDDSI Framework — International Dysphagia Diet Standardisation Initiative
• Creation and Initial Validation of the IDDSI Functional Diet Scale — PubMed Central, National Library of Medicine