Blenderized Tube Feeding: Part One

Tube feeding is used when one is unable to eat enough by mouth and swallow safely, or when additional supplementation to oral feedings is needed.

What is a blenderized tube feed?

Blenderized tube feeding (BTF) is defined as liquefied whole foods that are pureed in a blender, and delivered through a feeding tube. Historically, blended food was used for tube feeding. Over the years, standard, ready to use, commercial formulas have replaced blenderized food to provide nutrition when a patient is unable to eat by mouth.

Many families are becoming interested in returning to a more natural food source by tube feeding with homemade, blended foods. This can be a complement to a commercial standard formula, or replace standard formulas entirely.

Why should we consider blended foods instead of standard formulas?

Some evidence shows that BTF may:

• Improve symptoms of reflux
• Build tolerance and reduce sensitivities to foods
• Improve diarrhea or constipation symptoms
• Support the transition from tube feeding to eating by mouth, if this is a goal

Families also report that BTF can also help normalize the feeding experience so that the tube-feeding child is more fully included at the family dinner table.

There are many pros and cons to consider when making a decision to offer BTF. A registered dietitian (RD) can provide guidance and help create the BTF recipe, to ensure that it contains the correct amount of calories, protein, fat, vitamins, minerals and water for your child’s health and development.

When deciding if a BTF program is right for your child

Consider the following:

• Health and medical stability: Your medical team can advise if BTF is a good fit for your child given overall health status. Both a steady growth trend and healthy immune system are required.
• Age: The American Academy of Pediatrics recommends that children be 6 months of age before introduction to blended foods via a tube. The introduction should be managed gradually, trialing small amounts of single item foods every three to four days.
• Route of tube: BTF is only approved for use via a G-tube (gastrostomy), which goes directly into the stomach. Other tubes, like NG (nasal-gastric), OG (oral-gastric) or J-tube (jejunostomy) are not suitable for the BTF diet. NG and OG tubes are too small; the J-tube feeds the jejunum, which is not designed to break down whole foods and could make your child ill if whole food is delivered.
• Size of tube: A minimum 14 French-size tube is necessary to safely provide BTF. A smaller tube size is not safe and could clog.
• Pump vs. bolus: BTF should be delivered only via bolus feedings. This means that the entire amount of the feeding is given at once. BTF is not suitable for continuous feeds with a pump, because the blenderized food is more likely to grow bacteria as it hangs at room temperature, just as food left unrefrigerated spoils if left out too long. In addition, the pump is more likely to clog when blenderized food is used.
• Expense: BTF can be more expensive than commercial formulas, particularly if the commercial formula is a covered by insurance (as additional food costs will not be covered). Other expenses include special tools such as a high-speed blender and measuring/storing equipment.

Please remember that your doctor or RD should approve any changes made to a tube-feeding regimen. There may be other important medical factors that they will consider when determining if blenderized tube feeding is a suitable choice for your child.

Stay tuned for BTF Part Two: next week, ingredients and a sample recipe will be presented.