Blended Diet Part 2: How we got started

We Choose REAL FOOD!!!

This post will go into detail about how we started our Blended Diet and the steps that followed.  A pretty technical post that may bore those who are not looking to start this form of diet themselves.  :)

All of our ingredients and measurements are calculated to Noah's specific size (33" long), weight (24-27 pounds), and age (20-22 months old) and dietary goals (he needed to gain a couple pounds to start and then maintain for a few months).  We found a dietitian that was willing to help us out and we have had regular blood draws to measure his levels (calcium, protein, vitamins, minerals, ect) so that we can adjust his recipes accordingly.  Each person is different as well as their dietary needs.  Noah currently does not have any form of hormone issues, allergies, or dietary restrictions so we have been able to pick from a variety of food options in creating his meals.  The one are we had to watch closely was the rate at which he was to gain weight.  He is severely low tone and very immobile getting little calorie burning exercise a day.  We had to consider this in every meal so he didn't get too big too fast and hinder his movements or abilities. Noah also had eaten many real food items in his past and we knew that his body could handle real food. 

Goal:  Have Noah gain 2-3 pounds with a well balanced meal plan and then maintain that weight without gaining or losing more than a few ounces for an additional few months.  Then we re-access at that time.

Guidelines:

• Total caloric intake of 900-1000 calories a day.
• 34 ounces of free liquid a day (24 hours)
• 15-20 grams of Fiber/day
• 12-15 grams of protein/day
• Keep recipe well balanced  

Recipe Elements: 

• Vegetables
• Fruits
• Protein
• Grain
• Fat/Oil
• Liquid (preferably calcium fortified)
• *Spices-optional
• *Vitamins-optional

Challenge: getting enough calories to fit into the volume we needed.  Noah can only tolerate 4-6 ounces of anything in his stomach at one time so we have to make sure to pack in everything into that volume while still following all of the above "guidelines" 

Blender: You must have a really high end blender (Vitamix, Blendtech, Ninja) once you get into blending food like whole grains, meats, raw vegetables, ect.  It has to blend well enough to make it thin enough to flow through the feeding tube without clogging.  If you are starting like we did with baby food then you can use pretty much any blender.  We used the baby bullet and it worked great as long as everything you are blending is already the consistency of baby food. 

Tricks & Tips: lessons learned :)

1. mix all liquid and soft foods first then slowly add in dry foods
2. blend multiple times to ensure smooth texture
3. use a strainer if you are not sure if there are any clumps
4. have a towel, washcloth, or paper napkin around as there are messes
5. scrape out blender you will be amazed at how much is still in there
6. have a large space on your counter for this process
7. save all baby food jars if you plan on freezing your own foods
8. If you save food in the fridge for the next day measure out your meals and then let sit overnight.  Then the next day add in the extra water/fluid you will need.  Grains absorb fluids and make the meals really thick over night
9. This is real food and can grow bacteria if not kept clean or cool.  Always put an ice pack when packing this food around with you.  Would you eat your breakfast food at 8pm if it has been sitting out on the counter all day?
10. warming food before you feed it to your child makes the meal smoother and thinner 
11. If you freeze your food/meals only fill the container partially as it will expand once frozen
12. Aim for a rainbow of colors for his foods (veggies & Fruits).  different colors means different minerals, vitamins, and nutrients. 
13. We opt for variety at all time but if your doctor is okay with a strict but balanced recipe then giving your child the same food each day is just fine.  But talk to your doctor or dietitian first.
14. Certain foods make blends really thick-Avocados, bananas, quinoa, starchy foods, ect- watch out for these
15. Certain foods make blends to thin (volume issue)- fruits (melons mainly)
16. Certain foods are more prone to cause clogging issues- berries, whole prunes, things with tough skins or seeds, hard grains, ect
17. Dairy milk froths when blended and can alter measurements

Equipment (other stuff you 'might' need):

1. Blender
2. measure cups and spoons for both dry and liquid goods
3. a fine mesh strainer
4. a spatula
5. a cloth for messes
6. 60 cc cath tip syringe(s)
7. all your food and vitamins and medicines
8. pump bag (if you go this route)
9. If you plan to make ahead of time and save or freeze have your jars, bags, pouches, or cups clean and ready to be filled.

Week One:  We replaced one formula meal with one full blended meal.

• we chose the easy route since Noah was still a toddler and went with baby food.  Not the cheapest option but since we both work full time this was the best option for us. 
• He was still getting most of his nutritional needs through his formula this week.
• 4 bolus feeds during the day (8am, 11am, 2pm, 5pm) over 1 hour and a 10 hour continuous feed during the night of water or water with formula to meet his free liquid and calorie goals. 
• We still ran his BD meal over the same 1 hour time frame to start.  
• 2-3 times a day about 30-60 minutes prior to each meal we would flush him with 1-2 ounces of water.  This helped meet his liquid goals as well as "clean out" whatever food was still in his stomach to make room for the next meal.  ***free water without anything in it does not digest therefore it absorbs in the body within 20-40 minutes and will not make you feel full or take up any room in the stomach for each meal. 

Recipe: (total of 150-250 calories needed for this meal)-high end if he vomited his earlier formula or not. We gave this one BD meal to him at 5pm each day to start. 

• 1 ounce protein (Gerber meat-chicken, turkey, ham, beef...with gravy)-50 calories
• 2 ounces vegetables (Gerber sweet potatoes, peas, or carrots)- approx. 40-50 calories
• 2 ounces fruit (Gerber pears, apples, mixed fruit)- approx. 40-50 calories
• 1/4 cup calcium fortified liquid (dairy, rice, soy, almond milk)- approx. 20-30 calories
• 1 tsp oil (flax seed oil w/omega 3, olive oil, coconut oil)- approx. 30-40 calories
• 1/4 cup grain (baby cereal-rice, multi grain, oatmeal)-60 calories
• Vitamin D-400 units
• 1/2 tsp Probiotics

Week 2&3: We continued to follow this same recipe for weeks two and three but started to experiment with different baby food options.  We also started to introduce 2 BD meals a day by week three at the 2pm and 5pm meals.

Week Four: We stayed with the same guidelines as the prior weeks but now we started to add in adult foods.  We were still doing 2 BD meals a day and 2 Formula meals a day along with the continuous night feed of water and/or formula depending on if he met his calories and liquid intake. 

Recipe: (total of 300-450 calories needed for these 2 meals) 

• 2 ounce protein (Gerber meats, tofu, ground turkey/beef, peanut butter, grilled chicken, roast)
• 4 ounces vegetables- 2 oz of 2 different options (Gerber foods, edamame, kale, spinach, frozen mixed blends, grilled squash)
• 4 ounces fruit- 2 oz of 2 different options (Gerber fruits, fresh fruits, prunes, applesauce, fruit cups, frozen fruit)
• 1/2-3/4 cup calcium fortified liquid (dairy, rice, soy, almond milk, broth or stocks)
• 2 tsp oil (flax seed oil w/omega 3, olive oil, coconut oil)
• 1/2 cup grain (baby cereal-rice, multi grain, oatmeal, brown rice, quinoa, flax seed, Mill seed, hemp hearts, multi grain cheerios, couscous, whole wheat pasta, whole wheat bread, ect)- stay around 120-160 calories
• Vitamin D-400 units
• 1/2 tsp Probiotics 

***I started to run into volume issues once I went to two meals a day and learned to adjust my food choices depending on how juicy they were or how thick they blended.   Trial and error. 

Week Six: FULL BLENDED DIET (900-1000 calories/day)-

**We stayed with the four bolus feeds during the day but adjusted the times to fit his needs.  He is more gaggy in the mornings so we do a 4-5 ounce feed at 8am and then increase it to his now 6-7 ounce total dose/meals throughout the day depending on how he is feeling.  If he eats 6+ ounces in one meal then we wait 3.5-4 hours for his next meal (starting from the time he started his last meal).  Whereas before he was starting each feed 3 hours after he started the last one. 

**We still are giving him 2 ounces of free water in-between each meal and are still running him over a 10 hour continuous feed at night but now it is only water.  We still are unable to meet his 34 ounces of fluid goal during the day alone at this point. 

Recipe: (total of 900-1000 calories needed for these 4 total meals) 

• 2 ounce protein (Gerber meats, tofu, ground turkey/beef, peanut butter, grilled chicken, roast)
• this does not increase because it meets his protein goals with only the 2-2.5 ounces.  
• 8 ounces vegetables- 2 oz of 2-4 different options (Gerber foods, edamame, kale, spinach, frozen mixed blends, grilled squash, ect)
• 8 ounces fruit- 2 oz of 2-4 different options (Gerber fruits, fresh fruits, prunes, applesauce, fruit cups, frozen fruit, fruit juices, ect)
• 1-1.5 cup calcium fortified liquid (dairy, rice, soy, hemp, almond milk, broth or stocks)
• 2 Tbs oil (flax seed oil w/omega 3, olive oil, coconut oil, other oils)
• 1 cup grain (baby cereal-rice, multi grain, oatmeal, brown rice, quinoa, flax seed, Mill seed, hemp hearts, multi grain cheerios, couscous, whole wheat pasta, whole wheat bread, ect)
• Vitamin D-400 units
• 1/2 tsp Probiotics
• Multi-vitamin-currently Noah is on 1/2 of a child's Flintstones type multi-vitamin

I have also started to make my own veggie and fruit blends.  Here are my two first blends that I came up with.  I keep these in my freezer and then pull what I need out the night before to thaw in the fridge until I mix it into my meal blend.  (I plan on dong many more of these)

Simple Veggie Blend:

1 entire Costco size bag of Frozen Normandy-Stye mixed Vegetables
1 entire grocery store brand bag of shelled steamed edamame
1 entire grocery store brand of frozen kale

• Cook everything according to directions
• Blend 3-4 cups mixed veggies, 3 Tbl edamame, 1/2-1 cup kale, and 1 cup water in batches.
• Pour into your freezer safe containers, label with date or keep note of the date you made these.

When I did this it made 34 (4 oz) containers.  I used cleaned baby jars to freeze these in.  Each container is roughly 45 calories, 2-4 grams of fiber, and 2-4 grams of protein.  I did not label these as I want to use them again in the future.  I put them in a box in our freezer and labeled the box instead.

Simple Fruit Blend:

1 extra large cantaloupe
1 regular sized can of Dole pineapple without the juice
1 regular sized can of pears with the juice
1 regular sized can of pears without the juice
3 regular sized apricots

• Cut the Cantaloupe and remove all seeds.  Dice up the fruit in chunks and throw away the rind.  
• open your three cans of fruit and drain the juice out of the pineapple and one pear can.
• Cut apricots in half and remove seed
• split into two batches of equal portions
• blend away :)
• Pour through a strainer before jarring.  The pineapple will leave a ton of fibers that may cause clogs in your pump tube.

This makes a ton of liquid and frothy volume.  I let it set out for a few minutes to let the bubbles settle.  I then poured into 23 (4 ounce) baby food jars.  I calculate each jar is roughly 60 calories. 

We are still in the learning process as you can tell but I think we are making ground on this whole blended diet thing.  We are currently making two days worth of food at a time and keeping them in the fridge ( I plan to expand this to a full week at a time).  I have personally found that using reusable baby food pouches is our best option.  We have recently purchased the Yummi Pouch which can hold 6-7 ounces of food at a time, opens from the top which I love, fits a 60CC cath tip syringe in the screw off port, cleans really easy, and the bottom expands as you put the food in it and it doesn't tip over while filling. There are many brands of reusable food pouches on the market right now.  I make 8 (6-7) pouches every other day right now which makes it really easy to bring to daycare and on errands.  I use a wine bottle freezer sleeve/pack to slip the the food pouch in while running errands to keep it cool inside his pump backpack. To fill these pouches I have found the easiest method is to either use a large 60cc or 100cc cath tip syringe or to use a measuring cup that has a long narrow spout.  

There are many many blogs, networking groups, websites, and books that offer a variety of other tips, tricks, and recipes.  I am not by any means an expert in this area but I still wanted to share with you our journey and how we got started.  I find myself researching new recipes daily and it is almost a game for me to find one that has the perfect amount of volume/calorie/guideline balance.  I notice a major difference in Noah since starting him back onto real food again. 

I have also met a wonderful tubie friend who is in the process of starting her own line of Complete Tube Fed Meals.  I can't wait until she is in full production :) Check out her website and her adorable Chief Inspirational Officer: JustFood