Infant alimentation by nasojejunal tube feeding has been successfully used since 1973. A significant complication is small bowel perforation by the tube; three cases are presented. The differential diagnosis includes spontaneous gastric perforation and necrotizing enterocolitis. Nasojejunal tube perforation almost always occurs in the distal duodenum. It is likely the result of peristaltic activity which propels the tube along the relatively rigid duodenal loop. Thus it is preferable to position the tube end distal to the ligament of Treitz.