The BLENDS Project
The BLENDS Project
Before deciding to start using blended food there are a number of things you should take into consideration including:
Blended food works best with gastrostomy feeding tubes (these tubes are placed directly into the tummy). If you want to use blended food and your child has a nasogastric tube (a tube which goes through the nose to the tummy) or jejunal tube (further down into the small bowel) you can discuss the possibility of changing the type of tube with your child’s healthcare team.
Professionals often advise it is best to use a balloon-retained tube because you can be trained to change this yourself at home — just in case the tube is blocked or damaged.
A blocked disc retained tube on the other hand would need to be replaced in hospital.
Better still, using a gastrostomy ‘button’ means it is far more likely the extension set would be the part to block. The extension set can easily be taken off and washed or replaced.
Feeding tubes come in a variety of widths this is measured in French gauge or Fr. The thinner the tube the thinner the blend recipe will need to be to pass through the tube this could mean it is too thin to help reflux, retching and vomiting symptoms. It also means more pressure is needed to push the blended food through the tube, which could increase the risk of the tube splitting. Most families who use blended food have a 12Fr tube or wider.
Nasogastric tubes are very long and thin (6Fr or 8Fr) this means a lot of liquid has to be added to the blended food to make it thin enough to pass through the tube (which is likely to make is less effective at reducing reflux, retching and vomiting symptoms). Because the tube is long and thin, more pressure is needed to push the blended food through the tube, which increases the risk of the tube splitting.
If a nasogastric tube splits the blended food could go into the lungs which would lead to chest infection. If you have a nasogastric tube and would like to use blended food please discuss changing to a gastrostomy tube with your healthcare team.
Jejunal feeding, further down the intestinal tract, past the stomach, is sometimes used to reduce reflux, retching and vomiting symptoms.
It could be dangerous to give blended food directly into the jejunum for three reasons:
Blended diet can be better tolerated, meaning it's possible to feed into the stomach. It is better to use the stomach if possible. Some children are fed blends into their stomachs in the daytime and enteral formula at night time into their jejumum. It's best to discuss all the options with your child's healthcare team.
Using blended diet is not an easy option and it involves a lot more time, effort and money compared with using a commercial enteral formula. For example, you will spend time planning meals and shopping for food ingredients. You may need to invest in new kitchen equipment such as a food blender or storage equipment and a second freezer if you are going to batch blend.
I don't want to be negative because we've obviously all seen how many positives there are, but I think we need to be honest, this isn't the easy route. It is time consuming and it can be expensive.
I spend every Saturday, batch cooking, blending, freezing, and portioning, and that just becomes part of your life.
From a practical point of view, it [blended diet] is actually more awkward because with the milk [commercial formula] you get it delivered and you just stick the tube in, hook it up and it’s gone. With the food you’ve got to buy it, you’ve got to prepare it, you’ve got to make it, you’ve got to keep it fresh and refrigerate it, use it before it’s gone past it, and of course there is more stuff to clean up too.
A freezer full of batch made blends
Although blended diet takes more time and planning in comparison to ready to hang formula many parents enjoy being able to shop, prepare and cook for their tube fed child.
You get a kick out of it. I hate doing it sometimes, especially when I think he’s got two meals left and I look in the freezer and there is nothing, that is a horrible feeling. Even sometimes when I don’t want to do it and I’m really quite grumpy about having to do it I end up enjoying it. It’s really weird, there is something about it. It feels really good.
The idea that you can give blended food through a feeding tube is still relatively new. There were concerns that the use of blended food could increase the risk of tummy bugs, feeding tube blockages and micronutrient deficiencies. However, families for many years have shown it is possible to provide safe, healthy, well-balanced diets using blended food without blocking the tube. To do this it is best to seek the support of your child’s dietitian.
Many registered Children’s Home Enteral Feeding dietitians now have experience supporting families who use blended food, especially those working in Children’s Home Enteral Feeding. Nurses and Doctors and the team around your child can also support you. Just ask your team.
It’s worth considering where outside of the family home your child is fed. Before you start using blended food you may wish to speak to the teams in these settings and ask if they would be able to prepare and give blended food through the feeding tube.
Each setting will be different; it will depend on the kitchen and storage equipment available and the confidence and abilities of the staff.
The hospice that we are associated with they are very pro-blended diet they even have a blender there and for most children that go there who have a blended diet it is totally normal which is very nice.
Nursery are happy to give blends now but he starts school in September so I am preparing myself for another battle then.