Enteral feeding tube use among pediatric patients and nurses' knowledge in China: a 52-hospital point-prevalence and cross-sectional survey study.

Background: Enteral feeding tubes are widely used in pediatric patients, but tube-related complications remain a safety concern. Understanding current practice and nurses' knowledge is essential for improving the safety of enteral feeding tube placement and guiding evidence-based pediatric care. Aim: To investigate the current status of enteral feeding tube placements in hospitalized children in China and to evaluate nurses' knowledge and experience of enteral feeding tube management. Methods: A cross-sectional point-prevalence study was conducted between 4 and 20 December 2024 across 52 hospitals in China to identify hospitalized children with enteral feeding tubes. Data were collected by trained nurses. Concurrently, a survey was conducted among 11,787 pediatric nurses in the same hospitals. Descriptive statistics and binary logistic regression analysis were used. Results: A total of 2,875 children with enteral feeding tubes were included. The national prevalence of enteral feeding tube placement was 7.7% (2,875/37,114) of all hospitalized children. The highest rates were observed in general hospitals with pediatric departments (14.4%), followed by maternal and child health hospitals (11.6%) and children's hospitals (6.4%). Pediatric intensive care units (PICUs) (39.2%) and neonatal units (35.5%) were the primary units where patients with enteral feeding tubes were located. Orogastric (54.9%) and nasogastric (41.1%) tubes constituted the majority of feeding tube types. Among 11,787 nurses, 91.0% reported gastric tube placement experience, yet only 19.2% knew the nasal-tip-earlobe-midpoint-umbilicus method for correct tube length measurement and 8.8% were aware of the recommended protocol when gastric contents cannot be aspirated from the tube. Only 7.0% had post-pyloric tube placement experience, and 51.6% were unaware of the recommended flushing frequency of every 4-6 h during continuous infusion. After adjustment, nurses' correct responses showed item-specific associations with geographic region, hospital type, department type, and nurse-level characteristics. Nurses in East China and South China generally had higher odds of correct responses for most knowledge items, and nurses from general hospitals with pediatric departments and PICUs showed higher odds for selected items. Higher education level and managerial position were associated with correct responses to some items, whereas longer pediatric nursing experience was not consistently associated with higher knowledge accuracy. Bedside ultrasound and X-ray were the primary tools for post-pyloric tube placement guidance and post-placement verification, respectively. Conclusion: This nationwide study identified substantial and item-specific gaps in pediatric nurses' evidence-based knowledge of enteral feeding tube management. Standardized institutional protocols and targeted evidence-based education tailored to clinical settings and specific knowledge deficits are needed to improve the safety and quality of pediatric enteral tube feeding care.