Background Nasogastric tube insertion (NGTI) is one of the most uncomfortable medical procedures. Discomfort, pain and distress in children undergoing NGTI remain significant challenges and there is limited research into effective comfort strategies for this patient group.

Aim To investigate the challenges and complexities of NGTI in children under the age of ten years and develop recommendations on mitigating procedural distress and trauma by examining the beliefs, attitudes and experiences of healthcare professionals and parents.

Method A qualitative research methodology was used involving guided discussions with two focus groups of seven and nine participants, respectively. Data analysis was performed using inductive latent content analysis.

Findings NGTI commonly caused distress to all involved – children, parents and healthcare professionals. There was a lack of consensus and consistency in NGTI practices and a range of contextual barriers to improving the care of children undergoing the procedure. Four guiding principles for improving NGTI practice emerged: critically questioning the necessity and timing of NGTI; taking the time to develop and apply an individually tailored approach; ensuring child-friendly conditions and working as a team to implement comfort strategies; and conducting post-procedure team debriefing and reflection.

Conclusion There is a need for a holistic approach to NGTI that includes dialogue between all involved, the development of evidence-based guidelines and comprehensive training in technical delivery and comfort strategies.