Why Do We Feed Our Children Real Food Aka Blenderized Diet

Why do we feed our children real food aka blenderized diet? I am
transitioning my one year old to a blenderized diet because it feels
right and natural to offer him the same food our family and sociey
consume. I am interested to know why other families offer thier
children blenderized diets? I know that pediasure is a suitable
nutrition but what does make real food so much better for our
children... Does anyone have links or resources that document the
amazing effects of feeding our tube kids real food?
Ok so my husband posted online that we were looking for some help
within our community to get a vitamix blender and the replys we got
are shocking. One person sent us $60 cash in the mail with no contact
info only a copy of the posted picture of our son with his g-tube;
however, we recieved several commentaries on why we would even
consider a blenderized diet. Below is the response (and my e-mail)
that we recieved the other day via e-mail. ~ PLEASE read it~ I have
the support of my son's pediatrition as well as our hospital's
pediatric dietican and his speech and OT therapist. Everything that I
have heard supports a blenderized diet for (most) g-tube kids for
both physical and phycological reasons (read my reply to this woman
below). I was shocked to have her question the saftey of my child! As
far as I am concerned if pediasure is such a perfect nurtition then
why are parents of "normal" oral kids allowed to "expierement" with
a "traditional diet". My son's nutritionalist said that pediasure was
little more than whole milk, karo suryup ( I think), and vitamins and
that many parents make thier own; how can this be the perfect
nurtrition that this woman claims it to be... grrr it just frustrates
me, she is intitiled to her opinion but how dare she question my
son's saftey and his entire medical care team! Does anyone have any
input as to how to reply to this lady? Has anyone ever encountered
such criticism to a blenderized diet? I would be very appreseative of
any input.
Thank you,
Sarah and Baby ZAk ZAK
From experience I would say that your above contention is false.
Pediasure is prescribed because of its availability and ease of
digestion. What you are describing, no one can even fathom why a doc
would recommend such a course. The whole point of G-tube placement is
to provide liquid nutrition where the patient is unable to consume it
orally for whatever reason. It isn't to replace eating all together.
What you are describing that your child has is called oral aversion,
and it isn't at all uncommon. You also stated earlier that your child
was intubated in the NICU. The intubating has been known to cause a
high curved palate, and this has been known to cause oral aversion.
Protocol dictates nutrition via tube in extreme cases, while
receiving speech therapy. This morning I asked about this to contacts
in the medical community here in Anchorage, no one could rationalize
feeding pureed foods via tube. It was suggested that doing so would
cause the child to never learn to overcome the oral aversion. Also it
was pointed out there would be too much room for error, which in turn
would be devastating to the subject. It was even suggested that this
whole scenario is fabricated. I am not going to even address that
possibility, but I will say that if you have a medical provider who
is suggesting this route, as you contend, for the absolute safety of
your child, please seek out a second opinion.
I have children who were born premature, and one who needed a tube
placed. I have also provided support for parents experiencing NICU
journeys for nearly 15 yrs now. I can give a list of highly
recommended medical practitioners here in Anchorage who have years of
experience with both tube placement and protocol as well as oral
aversion and the issues it causes. Please let me know and I would be
happy to send you names and numbers.
-----Original Message-----
Sent: Wed, 15 Nov 2006 11:57 AM
Subject: Re: [freecycleanchorage ] Cute 1 year old baby boy with
special needs could us...
Well we have considered all of the options and we as well as
Zachary's medical care team feel that the best option for Zachary is
to be on a blenderized diet. It really depeds why a child has a g-
tube as to what should go into it. Our medical socitey typically
reccommeds pediasure but if you ask why the reason is that it is a
convience nutrition that has made life easier for people taking care
of a person with a g-tube (ie in a hospital or assisted living
situation) and has become a habit to be prescribed. In some cases a
child/adults GI track is also comprimised and certain things are
handled better by thier systems. However, when a child with a normal
GI track is offered nothing but pediasure in thier diet they can
begin to develop GI comlications. The human body is not inteded to
sustain on a high calorie, high sugar diet alone. There are also many
benifits to offering a blenderized diet. To begin with the
child/adult' s digestive track and entire system benifit from all of
the first hand nutrients from fresh vegetables, fruits, fibers,
protiens, etc. In addition to the physical benifits studies have
shown that it also makes the person feel more included in the
family's normal lifestyle and not so different. The most important
reason why we want Zachary on a blenderized diet is really a
combination of all of these thing. We are hopeful that with continued
therapy that one day Zachary will be able and willing to consume some
of his nutrition orally and a blenderized diet it the best way to get
his body and mind ready for that.

When people criticize the use of a homemade blended formula with children, we need to put their comments into perspective.Every action or feeling that we have is based on our beliefs. And our beliefs come from many different sources.I have been working as a therapist with children who have feeding tubes for more than 40 years. In those early days, infants were on regular baby formulas, but as kids got older, formulas were homemade and included pureed foods unless the child had very specific medical needs (such as a metabolic disorder). But the whole medical and nutritional fields have changed drastically over the past 25 years. A large number of new and specialized formulas have been developed by pharmaceutical companies and marketed to doctors and dietitians.The selling point has been the ability to standardize the nutritional content of the formula and to meet specific nutritional needs, as well as to emphasize sanitation and convenience. What used to be a tube-fed meal for kids has gradually turned into a medical procedure with a medical product.I remember viewing a videotape many years ago about the Zevex pump where they kept talking about a "dose of formula".Dose is a term used to describe the amount of a medicine. Can you imagine feeding your other kids (or yourself) a "dose of breakfast" or "two doses of dinner"? Crazy, yes. . . but also reflective of a belief that tube feedings and their formulas are medical procedures.

There is another component here that is much less visible. We've seen huge marketing efforts by pharmaceutical companies to convince doctors to prescribe their products to patients. We've also seen the advertisements on television to sell potential consumers and make them believe that these drugs may hold the answer to whatever disease or symptom they have. In many cases we have seen simple symptoms (often nutritionally related) turned by the pharmaceutical companies into a new disease. These kinds of marketing efforts sell products and allow the pharmaceutical companies to make huge profits. Companies are always looking for new ways to increase their market; one of these ways is to expand the types of conditions in which their product could be prescribed or applied.We began to see this a number of years ago when Pediasure moved from a product that was targeted at children who had feeding tubes to being advertised for orally-fed children who had low appetites or slow weight gain.Parents were told in print and television advertisements that this was the product that would make their kid healthy, happy and energetic!Now we see Pediasure in grocery stores as a nutritious snack for all kids!

Unfortunately there has not been a similar amount of information on homemade blended formulas that would enable doctors, dietitians and parents to consider the alternatives and the nutritional and preparation facts about these formulas. As a result we have a generation of professionals who have been raised on a great deal of information about pharmaceutical formulas and little or no information on homemade blended formulas.It is very understandable that most of them would support and recommend commercial formulas for children who have feeding tubes. It is understandable that many parents who have seen advertisements about Pediasure would believe that it contains all the nutrition that a child needs. . . because that is what all of the information on the product tells them, and their doctor or dietitian supports its use.

This is slowly changing through a grass-roots effort to support the development and use of homemade blended formulas. This listserv group of parents and professionals is a great example of this trend. Several years ago Marsha Dunn Klein and I began thinking about developing a book that would provide information for professionals and parents about homemade formulas.This initial brainstorming session has moved slowly, gathering information and chapter contributions from parents, dietitians, and physicians that would educate and help those who were considering homemade blended formulas. The book is now nearing completion. We are in the final editing phase and are seeing the end in sight."The Homemade Blended Formula Handbook" will be a practical and informative tool for everyone, which will provide information that can balance the information provided about commercial formulas. It will enable parents and professionals to make the best decision for a specific child and family, based on the full spectrum of information and choices.We will let everyone on this list know as soon as it is available.

Suzanne

______

Suzanne Evans Morris, Ph.D.

Speech-Language Pathologist

New Visions

1124 Roberts Mountain Rd.

Faber, VA22938

(434) 361-2285 ext. 5

QUESTION:
This is a question about children who are 100% tube dependent, and have
adequate oral motor skills to eat safely. Do you recommend to parents that
they reduce tube feedings in order to promote eating? If yes, how do you do
this, by a percentage of kcal or fluid intake or need?
Do you place a time limit on the trial, or weight loss limit or number of
diapers limit?
And most importantly, what evidence would you cite to support your
recommendation?
RESPONSE:
The first step is to determine swallowing safety. It is imperative that
this be verified by direct contact with the clinician making that
determination or a written document, and not just by a parents report.
Transitioning to oral intake will more than likely involve a team approach,
including a feeding therapist and RD at the minimum. The team may also
include a MD, physician assistant or nurse practitioner, and social worker
or psychologist. The child's primary medical practitioner must be aware of
the plan and support it.
In addition, the child and the caregiver must also be evaluated for
readiness. The child must be medically stable and have adequate growth
parameters. The caregivers must be willing to participate and able to
follow through on transition feeding plans.
The "team" needs to be aware of the reasons tube feeding was initiated in
the first place and agree on the best approach to help the child learn to
eat.
This approach may change depending on the child's or caregiver's response.
Transitioning from tube feeding to oral eating is not a single event, but a
process that can take weeks, months or years.
There are multiple factors from the child's history that determine the
approach, expectations and monitoring of a transition plan, including
medical conditions, previously an oral eater vs never an oral eater, length
of time on tube feeding, aversive experiences with feeding, and others (1).
It is also important to identify current factors that may interfere with
oral eating such as sensorimotor factors, behavioral/psychosocial factors
and medical factors such as GER or constipation. Factors that will motivate
the child to eat must also be identified. It is important for eating to be
a pleasurable experience with no stress or pressure to eat. It is
beneficial if the child experiences hunger and willingly comes to the table.
It is important that the child accepts the sight, smell, texture and taste
of foods/fluids. Positive reinforcement is key to increasing a desired
behavior. The long term goal is for the child to learn how to eat and drink
a wide variety and to self regulate appetite and intake.
Ideally, children should be on a bolus feeding schedule during the day that
mimics meals and snacks. This will assure that the child's stomach can
tolerate a bolus of oral food and/or fluid. Often it is necessary to reduce
tube feeding volume and calories to stimulate hunger. However, reducing
volume alone will not itself lead to oral intake. The child needs to accept
food and drink in the mouth. Therefore, it is helpful to increase feeding
therapy sessions and behavioral intervention to concentrate learning. If a
child progresses quickly, she may be able to tolerate a large reduction in
tube feeding such as 25%. If the transition is more gradual, a 10%
reduction may be more appropriate.
There are several centers across the country that provide "Intensive
Feeding/Weaning" programs. Some of these are discussed in reference #2. It
is difficult to answer the question about placing limits on the process by
using weight loss, number of diapers or a time limit. This will be
determined based on each individual and that individual's circumstances.
Children do not need to become dehydrated during the process as additional
water should always be provided. It is important to address hydration as
tube feeding formula is being decreased. Often, oral drinking adequacy
takes longer to achieve. Maintaining fluid intake through the g-tube will
also help maintain volume tolerance. Children often lose weight if the
strategy is an "intensive feeding/wean" approach. If this approach is used,
the child must be able to withstand a temporary small weight loss. If the
approach is very gradual, weight may not be negatively affected.
The usefulness of time limits is questionable, as there are likely other
factors that would determine strategies such as progression of feeding
skills, acceptance of food textures, ability to eat/drink adequate volumes,
as well as growth parameters. One recent review reported a range of 11-330
days to wean from tube feeding, depending on age, previous oral experience,
and medical condition (1).
There is no evidence-based research or guidelines in the literature
regarding the optimal way to transition from tube to oral feeding. Most
practice is based on clinical experience. A recent review of the literature
by Mason et al describes and summarizes the studies on this topic quite
well, and gives some suggestions for conducting future research (1).
In conclusion, the transition from tube feeding to oral eating is a process.
Caregivers need the help of the health care team to guide them and to
monitor their child's progress. It is the RDs role to assure that overall
nutritional status is maintained and that long term growth is not negatively
affected.
References:
1. Mason SJ, Harris G, Blissett J. Tube feeding in infancy: Implications for
the development of normal eating and drinking skills. Dysphagia, 20:46-61,
2005.
2. Glass, R.P., Nowak-Cooperman, K.M. 2003. Helping Children who are
Tube-fed Learn to Eat. Nutrition Focus 18:1-6.
3. Tarbell, M.C., J.H. Allaire. 2002. Children with feeding tube
dependency:
treating the whole child. Infants and Young Children 15:29-41.
4. Satter, Ellyn. 1987. How To Get Your Child To Eat .But Not Too Much.
Bull
Publishing Company, Palo AltoCalifornia.
5. Toomey, K., Ross, E. 2003. When Children Won't (or Can't) Eat: The SOS
Approach to Feeding. Conferences for Learning. Kay Toomey and Associates,
Inc. Denver, Colorado.

2) I am also sold on the Vitamix for tube-ready blends. No, you don't have to strain. If in doubt about lumps or particles, I let it run an extra minute.

1) Air can be whipped into the mixturesusing the VM, but several things help. It helps to tap the container a couple of times hard against the heel of your hand (hint: keep the lid on!!!). Or you can let the VM do the "tapping" by runningit on its lowest setting for 30 seconds at the end of the blending. You can also toss a chewable simethecone tablet in with the mixture to help break up the air bubbles so they escape better. In case of major air, we put it in a vacuum-seal canister and pump the excess air out with vacuum pressure, but I don’t resort to this often because it means extra dishes to wash. :0)