Paediatric Nasogastric Tube Insertion Practices Across Australia and New Zealand: A Survey of Clinicians.

Abstract

Background: Nasogastric tube (NGT) insertion is common and is associated with significant distress when performed in paediatrics. There is limited literature on methods to reduce pain and distress in children and adolescents. Objective(s): To (i) determine current self-reported practices of Australia and New Zealand clinicians relating to management of pain and distress associated with NGT insertion for paediatric patients, and (ii) compare perspectives between medical and nursing staff and (iii) provide recommendations for future randomised controlled trials. Method(s): Voluntary cross-sectional internet-based survey distributed through the Paediatric Research in Emergency Departments International Collaborative (PREDICT) and the Children's Inpatient Research Collaborative of Australia and New Zealand (CIRCAN) network between June and September 2023. Result(s): A total of 1258 clinician responses (267 medical, 638 nursing) were received. Overall, clinicians view patients experiencing more distress than pain during NGT insertion. The most common methods to reduce pain and distress were distraction (72.1%), lubrication (80.0%), and sucrose in infants (70.0%). Other interventions such as oral midazolam (23.6%), intranasal midazolam (22.2%) and nitrous oxide without fentanyl (21.1%) were commonly used in primary school aged children; similar patterns were seen in adolescent patients. Conclusion(s): Non-pharmacological methods to reduce pain and distress during NGT insertion appear to be widely accepted. There is wide variation in the use of pharmacological methods across Australia and New Zealand. Comparative effectiveness trials would help inform best clinical practice.Copyright © 2026 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.