Blenderized Tube Feeding Diet

August 28, 2020LifestyleNutrition

In this blog, we will provide an overview of the blenderized tube feeding (BTF) diet and which patients are appropriate for BTF. We will also discuss the potential benefits, contraindications, food safety guidelines, and suggestions for success if you are interested in BTF.

Blenderized tube feeding is defined as the use of blended foods and liquids given directly via feeding tube. This form of tube feeding was commonly used until the introduction of commercial enteral formulas in the 1970s¹. However, with society’s emphasis on incorporating whole foods into the diet, the demand for BTF is rising. Use of BTF is popular among the pediatric population for a variety of reasons. Many patients and families choose BTF because of its perceived health benefits as a more natural, “healthier” option and better tolerated than commercial enteral formulas. Many parents report improved growth and fewer symptoms of feeding intolerance (reflux, gagging and constipation) after switching to BTF ². In a study of 33 children who were post Nissen fundoplication, 52% of parents reported a 76-100% improvement in postprandial gagging and retching after the initiation of a blended diet³. Despite anecdotal benefits of BTF, the current medical literature on prevalence, safety, and outcome of BTF is lacking definitive data and more research is needed to support these claims.

Blended food is typically administered via gastrostomy tube (GTube) using a syringe or pump. The increased viscosity of blended foods can clog feeding tubes⁴. If BTF is used, foods must be well-blended and strained. Larger feeding tubes of at least 14 Fr also decrease the risk of clogging. Over time, some oils in BTF and medications can degrade the plastic that feeding tubes are made from. Always administer water flushes before and after feeds and medications to maintain tube integrity and minimize clogging. If you use a food pump to feed your child, keep in mind that flow rates may be slower than with commercial formula and blended food may need to be diluted or infused at a lower flow rate¹. Some feeding tubes are placed further down in the gastrointestinal tract in the jejunum (JTube) and absorptive capacity of protein may be limited, as protein is typically broken down in the stomach and duodenum in preparation for absorption. While there are cases of feeding BTF via J-Tube, there is currently not sufficient evidence available on whether or not commercial blenders sufficiently break down protein well enough for adequate absorption in the intestines⁵. Therefore, you should consult a physician or registered dietitian if you are interested in BTF and your child has a J-tube.

Food safety, sanitation, and storage are all important components of BTF preparation and handling. Prompt refrigeration is crucial and any unused formula should be discarded after 24 hours. Limit the hang time of BTF to 2 hours or less⁶. Commercial BTF hang times vary from 8 to 12 hours, based on individual manufacturer’s recommendations. Be sure to wash produce thoroughly and routinely sanitize blenders, utensils, and syringes to prevent microbial contamination⁷.

Blenderized diets are appropriate for children over 1 year of age that tolerate enough safe foods to achieve a balanced diet. If your child has food allergies/intolerances, and/or complex medical condition(s), a blenderized diet may not be appropriate. You should also discuss your child’s feeding schedule, medical history, cultural/religious food beliefs, and preferred foods with your child’s medical provider prior to switching to BTF. Volume intolerance, fiber intolerance, and fluid requirements should also be taken into consideration, as BTF diets typically contain more fiber and less fluid than commercial formulas.

Good candidates for BTF are medically stable patients with steady growth and ≥ 14 Fr feeding tube and proven tolerance of bolus feeds. The caregiver should also have access to adequate resources and equipment (high-grade blender, refrigerator, electricity, access to clean water and food, storage containers) and knowledgeable medical providers¹.

Contraindications to BTF include patients with acute illness or immunosuppression, fluid restrictions, continuous feedings, intolerance to bolus feeds, and lack of a mature gastrostomy site that is free of infection. Patients with acute illness or immunosuppression are at greater risk from contaminated food and fluid restrictions can make it difficult to maintain adequate hydration.

A multidisciplinary nutrition support team with familiarity with BTF management is essential to support families. At a minimum, this team should include a pediatric gastroenterologist or other physician with specific expertise in nutrition and a pediatric registered dietitian (RD). The providers must have a basic understanding of BTF in order to support families appropriately that are interested in this food practice. Registered dietitians analyze age, height, gender, laboratory information, medical diagnoses, activity levels, weight, and growth goals to calculate calorie, protein, water, and micronutrient needs to develop an optimal BTF recipe. That said, you should always consult a registered dietitian before initiating a BTF diet to tailor the recipe to your child’s macronutrient and micronutrient needs and to ensure that appropriate electrolyte and maintenance fluid needs are met.

A tip from the Oley Foundation if you are just starting out with blenderized foods is to try a regular or less expensive blender at first, to make sure blenderized diets will work for you before purchasing to a high-performance blender. If you need financial assistance purchasing a high-performance blender (i.e. Vitamix, Blendtec, Oster®), try contacting the manufacturer, as some companies will reduce the price for those using blenders for medical use⁸.

Blenderized tube feeding regimens are very involved and require ongoing multidisciplinary collaboration, but with careful planning and appropriate follow-up you can ease these challenges and simultaneously provide a more natural nutrition source for your child. Blenderized tube feedings can help normalize the tube feeding experience by offering foods to your child that the whole family eats and improve psychosocial feeding relationships⁹. There are a wide variety of ready-to-use commercial real-food formula alternatives to homemade constructed recipes available and some are covered by insurance. We carry several of these formula options including, but not limited to Kate Farms, Abbott Pediasure Harvest, Nestle Compleat Pediatric, Nestle Compleat Pediatric Organic Blends, Real Food Blends, Functional Formularies Nourish, and Functional Formularies Liquid Hope. Contact us to learn more about these options.

Note: This information should not be used in place of the advice and direction of your physician and/or registered dietitian.

References

1. Oparaji, Judy-April et al. “Basics of Blenderized Tube Feeds: A Primer for Pediatric Primary Care Clinicians.” Gastroenterology Research. 2019; 12 (3): 111-114. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6575127/doi:10.14740/gr1192
2. Johnson TW, Spurlock AL, Epp L, Hurt RT, Mundi MS. Reemergence of blended tube feeding and parent’s reported experiences in their tube fed children. J Altern Complement Med. 2018;24(4):369–373. doi: 10.1089/acm.2017.0134.
3. Pentiuk S, O’Flaherty T, Santoro K, Willging P, Kaul A. Pureed by gastrostomy tube diet improves gagging and retching in children with fundoplication. JPEN J Parenter Enteral Nutr. 2011;35(3):375–379. doi: 10.1177/0148607110377797.
4. Sax H.C. Specific nutrients in intestinal failure: One size fits no one. Gastroenterology. 2006;130:S91–S92. doi: 10.1053/j.gastro.2005.11.047.
5. No author. Blended Diets. 2016. https://www.feedingtubeawareness.org/blended-diets/
6. Boullata, Joseph et al. ASPEN Safe Practices for Enteral Nutrition Therapy. Journal of Enteral and Parenteral Nutrition. 2017; 41 (1): 15-103. DOI: 10.1177/0148607116673053jpen.sagepub.com
7. Fessler, Theresa. Blenderized Foods for Home Tube Feeding: Learn About the Benefits, Risks, and Strategies for Success. Today’s Dietitian. 2015; 17 (1): 30 https://www.todaysdietitian.com/newarchives/011315p30.shtml
8. Fessler, Theresa. Home Tube Feeding with Blenderized Foods. Oley Foundation Lifeline Letter. 2014; XXXV (6). https://oley.org/page/HomeTF_BlenderFoods/Home-Tube-Feeding-with-Blenderized-Foods-
9. Weeks Caroline. Home Blenderized Tube Feeding: A Practical Guide for Clinical Practice. Clin Transl Gastroenterol. 2019;10(2):e00001. doi:10.14309/ctg.0000000000000001

Additional Resources for Patients and Families