There is a growing movement to including foods in the tube feeding diet. A blenderized diet, also called a blended diet or BD, is one that includes real food, not just formula. There is quite a range, from mixing jars of baby food purees with formula, all the way to completely blending whole table foods only.
You should consult a dietitian and your doctor before moving your child to a blenderized diet.
When is a Blended Diet Appropriate?
When a child is over one year old. Children under age one should still be receiving the bulk of their calories from formula or breastmilk. A blenderized diet isn’t recommended before one year because that is about the time when orally-eating children would transition to a diet that is mostly solid table foods. Some dietitians recommend introducing new foods one by one at age 6-12 months, just like you would for a child who eats by mouth. These foods, however, should not make up the bulk of calories until after one year of age.
When a child has enough safe foods to make a balanced diet. When a child has food allergies, intolerances, Eosinophilic Disorders, FPIES (Food Protein-Induced Enterocolitis Syndrome) or another medical condition that limits the number and types of safe foods in the diet, a diet of real foods may not be possible.
When a child has a G-tube. A blended diet is typically fed to the stomach, via G-tube. Because blended diets are often thicker than traditional formulas, NG-tubes may be too narrow for the food to be delivered. J-tubes are placed further into the intestines and blended food may be difficult to absorb there. While there have been cases of feeding a blended diet to the intestines, it is just beginning to be studied by the medical community. Proteins are broken down in the stomach and duodenum, and must be sufficiently broken down to prepare them for absorption. There isn’t any medical literature at this time looking at whether commercial blenders sufficiently break down proteins well enough to prepare for absorption in the intestines.
Important Things to Know About Blended Diets
You need to understand your child’s hydration needs. Blended foods will contain less overall water than formulas. It is necessary to include more water in your child’s diet compared to formula. Many people find that doing a water bolus about 30 minutes prior to a meal will prepare the stomach so that it is more easily tolerated.
You may need to increase calories in your child’s diet. It is pretty common for children to have more regular bowel movements with blended foods. Many people find that their child requires extra calories in order to maintain and gain weight.
If you are feeding a blended diet using a feeding pump, the flow rates may be a bit slower than when you are using formula. It is a good idea to do a test to see how accurate the flow rate is so you can adjust rates accordingly. Run the pump into an empty measuring container for 30 minutes to an hour and see how the volume pumped compares to the rate.
You can tailor the diet to the needs of the child. This can mean avoiding foods like milk or soy, or focusing on foods that are easier to digest.
A blended diet exposes a child to digesting real food. We have heard from older tube feeders that they are sometimes able to taste foods that are fed to the stomach. A number of parents report that children who move to a blenderized diet show greater interest in eating orally.
It may be an alternative when there are issues with getting formula covered by insurance.
Some parents feel that feeding food “normalizes” the tube feeding experience.
Focusing on the nutritional needs of the child who is tube fed may help the rest of the family focus on eating right.
Parents report the following once their child has moved to a blenderized diet:
Reduced vomiting and retching
Less constipation, more normal bowel movements
More comfort during feeds
Improvements in gastric emptying (which could be related to improvements in bowel function) that allows for feeding larger volumes or moving to bolus feeding
Converting a Delivery Set
Blending Start to Finish
The Mighty Vitamix
How to Feed a Blenderized Diet
Blended Diet Myths
We have heard a number of reasons why medical professionals do not support blenderized diets:
It clogs the tube. In practice, we hear more about medications clogging feeding tubes. Rarely have we heard of a blenderized tube feed causing a clog. It is important to use a commercial blender and blend well. If you aren’t using a commercial blender, you will need to strain your blends to avoid clogs.
It isn’t sanitary or there are concerns about food-borne bacteria. If you use the same guidelines you do when you are cooking or preparing food for the rest of your family, this shouldn’t be a big concern. There is some common sense that has to go into proper food preparation. Cook the foods that should be cooked, keep foods cold that should be cold, abide by expiration dates, and think about how long foods are good for in the refrigerator. We all eat left-overs, but we don’t eat them weeks later. Wash your counters, and wash your blender. Do the things you would normally do in keeping your food preparation areas clean. Moreover, it is important to keep perishable foods cool once they are blended. Blends need to be refrigerated and kept cool with heavy duty ice packs on-the-go or overnight.
It is harder to keep track of calories. It can be. But, if you work with a dietitian, you can get guidelines on basic recipes. You also start to learn how many calories are in different proteins, vegetables, carbohydrates, oils and fruits.
Blenderized Diet Options
There isn’t a “right” way to do a blended diet. It comes down to what works best for your child and your family.
Blending from Scratch
Some people blend every meal.
Some people blend each day.
Some people blend for several days at a time.
Some people blend larger quantities and freeze (only with ingredients that can be frozen safely).
Some people prepare components of their blends and freeze for later use.
Baby Food Purees
Some dietitians will suggest using a variety of pureed baby foods as either the base of the blenderized diet recipe or as an addition to a tube feeding formula.
Commercially Available Blenderized Diet
There are ready-to-feed options available now. They are increasingly being covered by insurance, including Medicaid. Using a commercially available ready-to-feed option may address the concerns that some medical professionals have about tube feeding real foods.
Some people use a formula as a base for the blenderized diet.