If you work with complex pediatric patients, you’ve likely noticed an increased use of blenderized, whole food, tube feedings. This month, we’re sharing our ideas and experiences with you after working with many families to transition from commercial feeds to blenderized.
Pros of Blenderized Tube Feeds
- The children who often benefit the most from a transition to blenderized feeds are those with tube feeding intolerance. Schmitz et al. confirmed this in their 2021 review, where they noted that all six studies they looked at showed improvement in gastrointestinal symptoms in changing from formula to blended feeds.
- Although many children receiving commercial tube feeds have their formula fully funded, this isn’t always the case. The option for a less expensive blenderized feed is an important consideration in some situations.
- Generally, families using blenderized feeds tend to report more personal satisfaction feeding their children, fulfilling that innate need to feed their child the ‘best’ way they possibly can.
Cons of Blenderized Tube Feeds
- There is a learning curve for families. Linking a beginning family with an experienced family who can share their ‘tricks of the trade’ can be invaluable to help in the early phases. With time, each family seems to find their way, developing a system that works well for them.
- A high-quality blender is a must with blenderized feeds, to ensure blends are fully liquefied, and to minimize the risk of tube clogging. This represents a significant initial expense; verify with leading manufacturers to see if they offer a program to assist with the cost.
- In their April 2022 review, Brekke et al. found that the average caloric concentration of a blenderized feed to be 1 kcal/mL. This matches our experience and is a consideration for a child who is volume sensitive, on a more highly concentrated commercial formula.
Transitioning from Commercial Formula to a Blend
Prior to beginning the transition to a blenderized diet, it’s important to have an honest discussion with the family as to what is involved. From there, as you would with any other tube feeding change, it’s usually best to transition gradually. Now, the speed of this transition is very individualized and specific to the family’s comfort level along with the child’s feeding history.
For blenderized feeds, we recommend using a 14-french gastrostomy tube and to push feeds via syringe. Feeding pumps could be considered, but the blend would need to be very thin, resulting in more dilute feeds.
In our experience, starting with 20- 25% of the feeds as a blend and the remainder formula works well. This can be done by either replacing one feed per day with a blend or by mixing the blend with formula in a 25/75 ratio. From there, depending on the child and family, we progress every 2-3 days in 20 – 25% increments.
Calculating Blenderized Feeds
You’ll find many methods out there for calculating the nutrient content and providing recipes for blended feeds. The strategy we most often use is an exchange system based on servings of fruit and vegetables, meat and alternatives, starches, dairy and fat. Calorie-containing liquids are counted in the exchanges. Salt is also added to the blends as many families tend to use minimally processed foods or unsalted foods. This will give you your nutrient base.
From there, the amount of fluid that is added to the blend will vary day-to-day. Enough fluid needs to be added to liquefy the blend +/- additional fluid to meet requirements. Some families will strain this final product prior to feeding.
As you have likely gathered, we are big fans of blenderized feeds for improving tube feeding tolerance and quality of life. Although there is a significant learning curve and time commitment for families, our experience is that the pros outweigh the cons.
We’d love to hear from you! What has your experience been like with blenderized feeds?
Until next time,
Charlene & Julie
P.S. Are you a dietitian interested in learning more about pediatric nutrition? Join our private Facebook group, Pediatric Dietitians – Newbies to Masters HERE.