A Few Common Problems

Blended diet usually gets easier once you've found what works for your child, but there can be a few hiccups along the way.

The blend won't go through the tube

Stop and don't force it.

Check the consistency of the blend, the tube and any extension or giving set. A blend that is too thick, contains lumps or hasn't been blended sufficiently can make administration difficult.

Follow your tube manufacturer's instructions and your child's clinical team's advice for dealing with a blockage. Different tubes and situations may need different approaches.

Never use excessive pressure to force a blend through a tube.

Try warm water to gently clear the blockage, using a smaller syringe and pulling back slowly.

If you have a button you may have no choice but to change it.  The valve is tiny and small pips can block it and nothing shifts it. 

If you cannot clear a blockage using the method you've been taught, contact your enteral feeding team.

My child is vomiting

Don't automatically assume that the blend itself is the problem.

Vomiting can have many causes, including the volume or speed of the feed, reflux, illness, constipation, medication or the composition of the feed.

It may be that the change is too much, too quickly  Sometimes it helps to take your time with switching to BD.

Try to identify what has changed and discuss persistent or troublesome vomiting with your clinical team.

My child seems uncomfortable

If they are swallowing, looking uncomfortable of distressed it could indicate the food is going in too quickly or the volume is too great. 

Look at the whole feeding pattern rather than just the food.

The amount given, how quickly it is administered, the consistency of the blend, hydration and bowel movements can all be relevant.

Sometimes a small change makes a surprisingly big difference.

The blend is too thick

A blend doesn't have to look like commercial formula, but it does need to be suitable for the tube and method of administration.

Check that the food has been blended thoroughly. Depending on the individual feeding plan, consistency and tube, sieving or adding an appropriate amount of fluid may help.

We use a thick batter like consistency.  If it runs off the spoon, however slowly, it works for us. 

Avoid foods that thicken the blend too much.  Pasta, white potatoes, avocado, rice, pastry and heavy carby foods.  Used in small amounts they're fine. 

Don't simply keep adding water to make a blend thinner if this means your child is no longer receiving enough energy or nutrients.

If you have to add more fluid make the fluid count, such as milk or smoothie juice.  

Ask your dietitian if you are unsure.

The tube keeps blocking

If blockages are happening repeatedly, don't just keep clearing them.

Look at the possible causes with your clinical team. These can include the consistency of the blend, tube size, equipment, inadequate flushing or medicines. Medication is a particularly common cause of enteral tube blockage and may need to be reviewed.

Using the best blender you can afford will help.  If you don't have a powerful blender avoid very difficult foods such as raspberries or nuts.

Sieve if necessary, but if there's a lot left in the sieve you will be losing fibre and nutrients.  I use a medium size sieve.   

If you have a small button or tube and the child is big enough, a larger button may help.  

My child is constipated

Simple steps are to increase water, increase fibre, give a stool bulking agent which the paediatrician can prescribe, such as Movicol.  

If possible upright toileting rather than nappies works better. 

Standing in standers helps with gut motility. 

If the problem is severe or long standing, medical advice is needed.  The longer a child goes without a bowel movement the harder the stool becomes, provoking overflow, which can be mistaken for a daily watery smelly stool, but is just an indication of constipation. 

If your child is in pain or vomiting or uncomfortable, this can also indication constipation. 

The area around the gastrostomy is sore

Contact your community nurse, as this is a problem which will only get worse is left untreated.  

It maybe due to overgrowth which is treatable. 

Sometimes the area between the button and the skin provide a warm moist climate, perfect for bacteria that live on the skin to multiply and cause skin breakdown.  If the button is too close it may need a different size.  Using small bamboo pads between the button and the skin keeps the area dry and may work for you, but if they get any fluid on them they must be changed immediately.  Otherwise change daily.  If they don't improve the situation, the community nurse can advise.  They worked for us and for others, but children are individuals. 

My child has gone orange

If the child's skin has gone an orangey yellow shade, its most likely due to carotonoderma, a harmless build up of carotenoids under the skin,  caused by a high intake of beta-carotene.  This is found in orange coloured vegetables like carrots, sweet potato, butternut squash etc.   

This doesn't cause Vitamin A toxicity.  It's not dangerous, and is more noticeable on the palms and around the mouth and nose.

Do not give a vitamin A supplement unless checked and prescribed.

Maybe explore alternative vegetables.  The colour can take weeks to months to fade.  

The whites of the eyes are unaffected.

If the child has yellow whites of the eyes, dark urine and pale stools as well as the yellowing of the skin, seek medical help. 

Something isn't working

One of the advantages of keeping a simple food and feeding diary is that it can help you spot patterns.

Record what your child received, how much, how quickly it was given and anything unusual afterwards.

Take this information to your dietitian or enteral feeding team.

You don't have to abandon blended diet because something isn't working. Sometimes the answer is simply to change one part of the plan.