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A BASIC GUIDE TO STARTING BLENDED DIET

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Starting Blended Diet needn't be daunting. This beginners guide is as comprehensive as I can make it, but there are plenty of hints and tips in my 'Useful Links' Section.

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Starting and transitioning

There is no single correct way to change from formula to blended diet. The best approach depends on your child's age, current feeding pattern, tolerance and nutritional needs.

Some children change gradually over several weeks. Others can introduce blended food more quickly. Some continue to have a combination of blended food and formula.

Some Points to Consider

Allergies

If your child has never eaten a particular food before, introduce unfamiliar foods cautiously.

If there is a history of food allergy, or your child has complex medical needs, ask your dietitian or allergy team for individual advice.

You may find it useful to introduce one new food at a time so that you can identify anything that causes a reaction or intolerance.

Let your child's tolerance guide you rather than following a fixed timetable

Medications

Some medicines may be absorbed differently depending on the feeding regimen, food and formulation. This can be particularly important for medicines (such as epilepsy meds) where consistent blood levels are important. Ask your prescriber or pharmacist whether any monitoring is needed when changing from formula to blended food.

If your child takes reflux medication, don't stop or change it without discussing this with the prescriber. Some medicines need to be reduced gradually.

Pump Feeds

Blended food can be given by pump in some circumstances, but pump compatibility, tube size, blend consistency and giving-set design all matter. Some pumps and giving sets are not suitable for blended food. Your healthcare team should advise on the equipment and settings for your child's particular needs. The current BDA Toolkit advises blends cannot hang for more than 2 hours. The Food Standards Agency says cold food is considered safe from bacterial contamination for 4 hours, but keeping within BDA Guidelines may be safer. The Kangaroo pump works with thicker food. The BD may need to be the same consistency as formula and sieved. Giving the bag a squeeze every 20 minutes or so helps sediment to not sit at the bottom, and reduces the possibility of blockages.

Starter Foods

Starter foods

Smooth foods with a predictable consistency can sometimes be useful when getting started. Commercial smooth purées are one example.

However, they are not necessarily nutritionally complete and shouldn't simply replace an equivalent volume of formula without considering their energy and nutritional content.

Your dietitian can help you work out how much energy and nutrition your child needs and how the blended food fits into their overall feeding plan.

Some research suggests the calories in food need to be greater than what the formula provides. So monitor weight too.

Volume Tolerance

Start with what your child already tolerates

Some children can introduce small amounts of blended food alongside their usual formula. Others need a more gradual change.

Children who have been continuously fed may initially tolerate only small volumes at a time. This doesn't mean they can never manage larger feeds. Increasing volumes gradually, at a pace the child tolerates, may help.

Children who are already used to bolus feeds may have greater volume tolerance.

Let your child's tolerance guide you rather than following a fixed timetable.

Weight Gain

Weight gain may take time and children respond differently.

Some children gain weight well after changing to blended diet, while others need adjustments to the volume, energy density or feeding pattern.

Regular monitoring of weight and growth is important, particularly during the transition. If your child's weight is falling, they are not gaining as expected, or you are concerned about their nutritional intake, speak to your clinical team.

Keep a record

A simple food and feeding diary can be very useful during the early stages.

Record what your child has received and note things such as:

vomiting or reflux;
bowel movements;
abdominal discomfort;
tolerance of different volumes;
hydration;
weight and growth.

This can help you identify foods that seem to suit your child and gives your dietitian useful information when reviewing the diet.

Formula and blended food can be combined

There is no prize for getting rid of formula completely!

Some children have a combination of blended food and commercial formula for a long time. Formula may provide useful additional energy, nutrients or fluid, while blended food allows ordinary family foods to become part of their tube feeding.

The aim is to find what works for your child.

Your child writes their own manual.