TUBE FEEDING &
MAKING A HOMEMADE INCUBATOR:
Tube feeding article by: Donna Wallen
I realize what follows will seem like a lot & all of it is not necessarily about tubing itself, but it really helps especially with the smallest babies. So I'll add what I know about neonates.
The good news is that tubing is relatively simply & relatively safe.
As long as you are sure that you are deep enough without going too deep you will be in the stomach. Unlike squirrels & especially bunnies a possum's food passageway is larger than their air passageway so you won't go into the wrong hole. You can get fluid into the airway, but not the tube itself if it is the right size tubing.
Ask your vet for both 5 french & 3 1/2 french feeding tubes. You will use the 5 french for all but the tiniest neonates. Basically a good rule of thumb is if they are starting to get any fur at all they can probably take a 5 & no fur a 3 1/2. However, if you have a baby just getting fur & the tube doesn't go down easily switch to the smaller size. Some babies have tighter throats than most & you don't want to cause pain. The reason for switching up to a 5 as soon as possible is that a 3 1/2 is so fine that it's harder to control & tries to curl up in the baby's mouth. It would be more likely to go down the wrong way too.
If your tube starts to age & get hard or stiff replace it. Check 3 1/2 tubes to make sure the holes on the sides are within 1/4 of the tube tip (this varies by brand). If not trim & file the end so it doesn't have any sharp edges. This is because a tiny neonate has a tiny stomach & you don't want the top hole to be above the mouth of the stomach.
Use the smallest syringe that will hold the amount of your feeding until you have some experience with tubing. This is because a small movement of the plunger of a 10cc syringe will expel a lot more formula than the same size movement on a 3cc (or 1cc for tiny neonates) & until you become sure of yourself this gives you a little more control.
Wash tubes with mild soap & LOTS of rinse water by drawing up the wash water & expelling it with the syringe several times followed by repeatedly rinsing the same way with clear water. Hang dry your tubes after forcing air through them with the syringe to clear out the water.
Warming tubes in warm water before using will usually make them softer & more comfortable for the baby.
Before you actually start to tube put a small piece of tape where you can get it easily with one hand. Eventually you'll be able to tell how deep to go with the tube, but when you are first starting you will need to mark your length.
I will write this for a right-handed person (me). If you are left handed reverse the instructions.
Hold the baby in your left-hand side up, facing your right hand. Lay the tube along (outside) the baby's head, neck, & body so that it lays over the mouth & runs down to the bottom of the rib cage following the neck line. The bottom of the rib cage is about the same point as the bottom of the stomach so now you can see how much tube needs to go inside the baby. Take the tape & mark the point where the tube would exit the baby's lips. You'll move this mark as the baby grows or for a different size baby so put the tape on lightly so you can move it. The good news is that babies in the same litter will *usually* be about the same size so you won't have to move it every time, just quickly check for length.
Now comes the actual tubing! Don't panic. This is easier than it may sound... How you hold the baby will depend on the size of your hands & what is both comfortable & functional for you. I have fairly large hands for a woman with long fingers. A married team of rehabbers that I know, both have very small hands & neither could do it my way. Ed actually holds the baby & Mary puts the tube in. The way I hold the baby is in my left hand with his back against the palm of my hand. My last 2 fingers are around his body supporting him & making him feel secure. My middle finger, index finger, & thumb control his head. (A lot of people only use the index finger & thumb for this. I just have enough finger length to use this to give me more head control on larger babies.) I hold my thumb up next to his little jaw (so he can't turn his head that way because my thumb's in the way), my middle finger under his chin, & my index finger dropped over his head (to prevent him from raising his chin). If your hand is not big enough forget about the finger over his head & put the index finger under his chin with the middle finger around his little body to support him.
Please know that the first few times you do this with any possum he's not sure what you're doing so he'll resist you. About the 3rd time (after you become comfortable, he can feel your tension) he will start looking forward to feedings & will actually help you by swallowing the tube right down.
This is not actually as "unnatural" for a possum as for our other native animals. Remember, the baby crawls into the pouch the size of a honey bee (the baby not the pouch) & swallows the nipple which then swells so the baby can't fall off easily. When you think about the size of a possum's nipples our tubes really are similar. They just go a little deeper. I've never had a baby that seemed to be at all bothered by tubing after they figured out that they were being fed. They just look surprised when they end up with a full tummy the first few times!
Hold the tube in your right hand & gently tickle the baby’s lips in front (not the side). If he doesn't open apply gentle pressure until he opens. Do not put pressure on the side of the mouth. You could hurt the jaw.
When he opens his teeth go into the mouth at a slightly upward angle to avoid catching under the tongue. Aim straight back so you don't catch in the cheek. (With a lot of animals you stay to the side to avoid the airway, but the possum's airway is smaller than the tube so that's not an issue. You will feel 2 snug spots on the way down. One is at the back of the throat (where you swallow) & the 2nd is at the mouth of the stomach. When you feel resistance wait just a second and gently wiggle the tube to tickle the restricting muscle & it will loosen. Go to the 2nd resistance & repeat. Stop when the tape gets to his lips.
DO NOT KEEP GOING. You can damage his stomach. Don't worry, that won't happen if you stop. I just saw someone try to put 4 inches of tube into a 4 1/2-inch possum. All you have to do is pay attention & you'll be perfectly safe.
**Always wipe off your tube after filling it & before tubing the possum so no liquid gets near the airway.
**Push plunger slowly when you are in the stomach. (Remember that the liquid comes out of the tube under pressure. If you push too quickly it's like water coming out of a garden hose with your finger over the end. You don't want to fill him up faster than he could take it in himself.)
**When you finish pushing the plunger WAIT! Count to 5 SLOWLY before you pull the tube out. The formula doesn't stop coming out of the tube the instant you stop pushing the plunger. You don't want the last drop coming out just as you pass the airway on the way out.
For neonates (naked babies):
You should use bottled water to make formula for any baby, but you MUST use it for babies under 25g. THEY CANNOT HANDLE THE BACTERIA IN CITY OR WELL WATER!!!
Think of neonates like the human babies in the pre-term nursery at the local hospital. Those babies are in VERY controlled conditions as close as they can be kept to the conditions of the mother's womb. We have to simulate the pouch for our babies.
If they come to you completely cold they probably won't make it. Your best chance is with the baby found quickly & kept warm.
I personally think that a lot of the loss of neonates is due to over heating them. The possum, because of being a marsupial, has the lowest body temperature of any of our native animals. (That's why they are the least likely to get rabies!) Anyway since I knew this & since I've had 3 mamas with babies in their pouches that I've had the honor of being able to watch closely I have actually checked the temperature in all 3 pouches. It was 83 degrees every time.
Humidity is higher & oxygen lower in the pouch than outside. Think about breathing into a paper bag. Air does get in through the paper, but the exchange rate is less & moisture from your breath will build up eventually.
I made pouches out of the fabric sleeve that doctors use under casts. I sewed one end closed & cut the other end long enough that I can suspend it inside a crab box (clear plastic box with slatted lid). I fold it down over the top of the bottom part of the box so the bottom of the bag doesn't quite touch the bottom of the box. I put a small piece of damp sponge in the corner of the box (not touching the bag - you don't want the bag wet) to increase the humidity. Make sure to check & re-wet the sponge regularly. You want it damp, not wet. I put the top on the box & fold the end of the cloth bag over the top of the box to reduce drafts & air transfer. (They can breathe fine through the cloth.) I also have a thermometer in the bag so I know if I need to raise or lower the pouch to adjust the temperature. Put a soft cloth in the pouch, put the box 1/2 on the heat & 1/2 off & as soon as your box warms up your good to go.
Tiny neonates often have a problem digesting formula, but thankfully this has not been the case of the ones that I've seen on Fox Valley formula.
There are some very small neonates 20g & less that have very tight throats. You might have 1-2 out of a litter of 5-7. Just be as gentle as you can, but know that their chances aren't good. The rubbing of the tube often causes the throat to swell, which makes it even tighter. A 3 1/2 french tube has a hole not much bigger than a hair so you can't really get any smaller & still get your formula through the tube. If you can't get food down them it would be kinder to put them down. They fight so hard to live, but starving is a horrible way to go...
Examples of feeding tubes. These are metal and while they can be sterilized and used over and over, I still prefer the soft flexible rubber tubes.
Flexible French Feeding tube.
The following page has a plain, printable chart you may use to keep track of the orphaned babies you take in.
TUBE FEEDING PICTORIAL:
When sliding the tube down, place the tube to the SIDE of their throats, not down the center.
Photo's Courtesy of Kim Bellman
MAKING A HOMEMADE INCUBATOR
Make by useing two tubs that fit inside each other. Fill the bottom tub with about 2-3 inches of warm water, which you can keep warm round the clock by useing a good submersible fish tank heater.
Line the tub with a soft blanket, then in the center place
a piece of wool cloth soaked with warm water, then a soft moist paper towel folded over to form a pouch for the babies, and over that and another moist wool cloth over them. Maintain inside temperature at 90 to 94 degrees and moist.
There is a place they can crawl to if they get too warm, it's just a piece of the bottom blanket that has been folded to make it thicker, the biggest trick here is to keep them warm and make them feel safe, that's why I keep them in the second paper towel, if you make a pouch they can stay warm in they are not as stressed.