BLENDED DIET FOR TUBE FED CHILDREN IN THE UK
Who is suitable for Blended Diet?
Step 1
Not every child or adult is suitable for Blended Diet however, with care, most people can be fed a full diet. A gradual build up is required and its important that hygiene standards are kept high.
Getting Started
There are several factors to consider when starting BD. The advice here is aimed at children with naso gastric tubes or gastrostomies and a normal digestive system insofar as they don't have short bowel syndrome or serious malabsorption problems. J tubes are also not suitable for BD unless they have a gastric port.
Good food hygiene
This isn't difficult, you just need a reasonable idea of food preparation. You are not creating sterile food, just be aware of the dangers of reheating food, storage, basic hand hygiene and so on. I decided to do an online food hygiene course recognised by C&G and, although I'm a nurse, I actually learned a great deal. At around £15 it was well worth it. Its not necessary of course but it will give you confidence in the face of opposition to produce a nice C&G certificate, and importantly it will tick one more thing off the risk assessment.
Good nutrition
Most people with children and especially those with a tube fed child they are looking to feed in an alternative way will have a good idea of child nutrition. The government website Change4Life has plenty of tips for healthy eating and there are any number of books of feeding children well. The brilliant thing is the child can be given a super healthy diet without even realising it.
Blending food
A way of blending to a fine smooth paste, the consistency of thick batter, which will go through the tube. Most people start with a hand blender, a normal speed blender and a sieve. The sieve is essential to begin with. You may find some foods like baby porridge or Ella's kitchen purees need no sieving, and this is where most people start. However the time comes when you need the high speed blender and they can be between £250-500. Some manufacturers give a discount so always ask. Some charities will fund, or local fundraisers. Failing that an interest free credit card or a rich relative! Its something that makes life much easier and keeps all the ingredients and leaves nothing in a sieve.
Facts
This is what this website should give you. Not just the basics and a shove in the right direction, but knowledge and an ability to say, "Actually no, the tube won't burst if I put food down it. Not unless I can exert the same pressures that are in a car tyre!" Truthfully though, its better to have your dietician on your side and fighting your corner. Luckily they are mostly reasonable people and would be doing the same thing in your position.
Important medication issues
It is very important that any medications you are giving which are carefully monitored for blood levels, such as those for epilepsy, are not increased or decreased because of a change to BD. BD may affect the way the body absorbs these medications so an appointment with the prescriber is very important before starting BD. They can then monitor the levels as the change to BD occurs if they feel it is necessary.
Be patient
The majority of blenders don't have to wait long at all. Most people see a reduction in vomiting almost immediately. Starting out is something as simple as changing one meal for a stage one baby puree like Ellas Kitchen. Depending on your child's previous eating or age starting BD is very variable. A child who has never eaten and had continuous milk feeds going over several hours will have a tiny stomach which will not tolerate volumes of any kind. They would need very slowly building up to take a full bolus feed. A child who had eaten fairly normally but was now unable to eat as much could eat what they could and have the remainder of the meal blended and bolus fed. A baby would be weaned as any baby would, only down the tube. Eventually most children will tolerate bolus feeds of varying volumes. The ideal is to feed a good volume in the same way most children eat only blended and tube fed. Theres nothing wrong with a child remaining on overnight feeds, or high energy formula drinks either indefinitely or until a suitable weight is reached and daytime meals can maintain that weight.
Don't be nervous
Its nervewracking to begin with but believe me, its easier than you think. Just think of it as feeding any child the only difference is you will be blending it and putting it down a tube. Facebook page 'Blended Diet UK' Is an absolute mine of information and has many newbie tubie feeders with lots of old hands giving them the benefit of their knowledge.
When to start
Personally we started before the dietician knew about it and I've seen that it is often better to do this just in case your dietician is against it. After all, they can't argue with a child who looks suddenly well, is not vomiting so much, and gaining weight. Ideally discuss BD with your dietician and care team before starting, especially if you feel they are sympathetic to a parent's need to feed their child as they feel is best.
This is an article in Practical Gastroenterology and it gives you some good guidelines on the easiest criteria for getting BD accepted. I've just put in the relevant information and put in a link to the whole article.
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Medically stable HEN (home enteral nutrition) patient
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Medical team support
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Dietician support and availability for guidance and direction
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Patient/family demonstrate understanding of good food practices, importance of clean equipment, etc
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Size of gastrostomy tube is > 14 french (however people have used smaller sizes with care taken not to block)
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G tube site has matured, healed with no infection with proven tolerance to bolus feedings
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Availability of bolus extension set for low profile G tubes
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Stable on commercial enteral formula (unless there is severe tolerance issue with commercial formulas)
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Patient/family motivated and willing to commit the time to prepare BTF (blended tube feed)
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Ability to follow recipe instructions and meet food safety guidelines
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Adequate financial and material resources (refrigeration, heavy duty blender, air tight storage containers, clean water supply, food, multivitamins
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HEN patient with joint jejunal/gastrostomy feeding tube should seek medical permission