Complications associated with nasogastric tube (NGT) are rare. We report one of these rare complications, NGT knotting, in the pediatric population. Our patient was a 7-year-old boy, a known case of β-thalassemia, who underwent laparoscopic splenectomy. He experienced NGT knotting. NGT knotting detection needs a high index of suspicion; if not detected and managed in a proper way, it may lead to serious complications. Recommended techniques to avoid this complication are discussed in this article.