Blended Diet Basics

Many of you know that Little B has a G-tube and uses it as his primary means of ingesting calories. The calories that we chose to feed him are from a blended diet, which is just “regular” food, blended up into a smooth consistency that can be pushed down a G-tube.  I work with a wonderful group that promotes blended diets (www.foodfortubies.com). Also, I’m a pretty big advocate of blended diets for folks who are medically able to ingest “real” food. If a person can’t safely eat real food, then for heaven’s sake, stick with the medical formula. But if medical formula isn’t working for you, consider giving a blended diet a try.

The important thing to understand is that there is no gold-standard “right way” to rule all other ways in blended diet. Here are a few questions that folks ask when they are starting out: 

                Concerned about volumes?

My favorite “false negative” about a blended diet is that you cannot make it as calorically dense as formula. How about this: blend up an avocado and a stick of butter. More or less calorically dense than an apple?  More calories than 1 calorie/ml? Oh, yes, darling. Oh, yes.  Let’s be honest: you can make your blend as calorically dense as you want. Think in terms of the difference between a farm breakfast of eggs, bacon and toast versus a salad without dressing. You can make your blend as calorically dense as you’d like, but the dietitian we use advised us against going over 1.5 calorie/ml. My son’s blend is at about 1.3 cal/ml. 

One thing to know about blended diet is that you can generally get about 50-100% more volume (over time, you need to stretch that tummy a bit!) in when doing a blended diet over formula. That’s a generality, but it proved fully accurate for us. In any case, Little B’s current volume is something like 1,200 ml of food and 500 ml of water. It varies a bit by the day, based on whatever we blend.

With BD, can you do the feeds more quickly using a syringe with less vomiting? Or do they have to be run over an hour like formula? 

For us, we absolutely can go more quickly and with less vomiting. Feedings take about 10 minutes. We use 100 ml syringes, and push the blended diet in as follows: 100 ml over 3-4 minutes (we do it in front of the tv to keep him still for a second), wait 20 minutes, then push in another 100 ml over 3-4 minutes. Little B went from vomiting 3-4 times per day when on Neocate to going to less than one vomit per week (usually due to me misreading the cues). It was that dramatic of a vomiting reduction.

                What is your feeding “schedule”?

Little B is not a morning eater – the tumor made mornings rough for him for the longest time, so we start slow. One thing to remember is that the schedule needs to work for you and your loved ones, so don’t be afraid to make changes when you see that they are needed.

8 am  -- 100 ml water

9 am  -- 200 ml food (100 ml, wait 20-30 minutes, 100 ml)

Noon -- 100 ml water

1 pm  -- 200 ml food (100 ml, wait 20-30 minutes, 100 ml)

5 pm  -- 100 ml water

6 pm  -- 200 ml food (100 ml, wait 20-30 minutes, 100 ml)

9 pm  -- 100 ml water

10 pm  -- 200 ml food (100 ml, wait 60 minutes, 100 ml)

1 am  -- 100 ml water

(He is sleeping for the 10 pm and 1am feeding/water)

Explain the whole free water/hydration thing to me.

Here’s a rough overview of how it works. First, figure out how much free water each day your child needs (there are formulas online, or check with your dietitian). Take the total amount of water she needs in a day and subtract from that the amount of liquid that is in her blend (that is, the milk, milk substitutes such as soy milk, and the juice). For the rest, that is what you need to do as free water. You will be amazed at how the free water will help push things through your child’s system. We do 100 ml of free water about an hour prior to each feeding, which helps most the residuals from the prior feeding through.

Does blending take a long time? Because my life is pretty hectic.

Little B’s blends take about 5 minutes total to blend. I do prep cooking once a month or so, which does take a few hours. I batch cook fruits (such as berries and peaches), vegetables, beans, and grains (grind first to make them quicker to blend). Once cooked, I freeze them in daily portions (for example, veggies are in 1-cup portion sizes).

I pull out the fruits, vegetables, beans and grains the night before and put them in the fridge. To do the blend, I just toss the defrosted food, milk, oil, and agave in the blender and turn it on. While it is blending, I make coffee. Then pour it into individual serving containers and put in the fridge. Pretty simple.

Also, consider how much of your time is spent dealing with feeding issues – cleaning up vomit from a bad feed, using the pump, mixing formula. Due to blended diet, I don’t have those tasks any more. I do have some prep work in the kitchen, but I actually enjoy those tasks.

                What do you actually put in a blend?

This is just a sample blend “recipe” – really, you can use anything that you know your son will tolerate. I use the USDA’s SuperTracker site to build Little B’s recipes (here: http://www.choosemyplate.gov/supertracker-tools/supertracker.html). Little B requires more than 1000 calories (which is what the USDA recommends for his age, so we just add more stuff).

½ medium banana

6 prunes

½ c peas (frozen, steamed)

½ c sweet potato (steamed and mashed)

2 c whole milk

1 hardboiled egg

1 T almond butter (or peanut butter or soy butter (also known as sun butter))

1.5 c brown rice, cooked in water

Blend the brown rice, prunes and 1 cup of the milk until smooth. Add the remaining ingredients and blend. If it is too thick, add a bit of water.

(Note: you can use any 1 cup of fruits and any 1 cup of veggies, just rotate them around. I like the prunes because they help with regularity.)

Calories: 1150