On Thursday, July 24th, we went to CHOC for an appointment with the GI Registered Dietitian to talk about doing a Blenderized Diet or Homemade Blended Foods for Whitney. When we went to the team eval to qualify for the inpatient, intensive feeding program, they recommended trying a whole foods blended diet. They said it helps the child's body prepare to digest foods that they will eat by mouth. It also is a good way to gain weight if they can tolerate it.
What is a Blenderized Diet? It is very simply, real foods pureed in a
blender and given via feeding tube. But it is also very tricky to
master. There are so many different ways you can do this. And the most
important thing is how the child with handle it.
There are a few blogs out there about families who have done BD's for
their children. I pretty much read them all! Here are some sites I found very helpful:
Also this new thing called Real Food Blends is looking pretty popular
and cool. They have pre-made blends specifically for tubies! http://realfoodblends.com/our-meals/
I have done BD for Whitney before. I was so excited to start it, but I
don't think she was quite ready for it. It was so healthy and fun to
do, but her little tummy couldn't handle very much. She had just gotten
her g-tube at 13 months old and we waited for a couple months to start
it.
Whitney never wanted to eat or be tube feed in the mornings. After
being fed water and formula all night, she was already full and not
hungry till 10 or 11am, when her night drip ended around 7 or 8am. In
fact, she recently stopped vomiting every single morning since we
started her on Cyproheptadine in Nov. 2012.
So now we have increased the rate to 75mls/hr and the dose is still
480mls, so it her night drip ends around 6:30am. And she will want to
eat breakfast around 9 or 10am.
For the past few months (since May or June 2014), after Whitney could
tolerate
bolus feeds again, I have been giving her some baby puree foods via
g-tube. She had done so well with that. I give it to her in the
morning around 8 or 9am, after she willing comes to the table to eat
breakfast. I'm just giving her store bought baby food pouch purees in addition to her formula.
For example:
greek
yogurt, kale, spinach, and apple (130cals)
banana acai granola
(90cals)
puree
banana, beet, blueberry (80cals)
banana
blueberry (90cals)
pumpkin, sweet
potato, pear (90cals)
spinach,
zucchini, pear (90cals)
They come in all different brands at the grocery store. They also vary
between 3-4oz per pouch. Most of them contain banana because it has a
lot of calories. I only give her the ones with the most calories per
oz. Doing it this way does not replace a carton of formula. I also
flush it with 2oz of water. It just really helps her and is so good for
her. When I give her formula in the morning, she always throws it up.
But since I've been doing this, she rarely throws it up. The other day
I gave her formula first thing because it was getting late and she just
threw up it as soon as it finished going into her. But when I give her
real puree food, she does great and then I can give her formula a
couple hours later and she doesn't vomit.
So I told Katherine, the RD, this and she thought it was great. She was
really nice and very knowledgeable about blended diets for tubies. So
we went through the book called Homemade Blended Formula Handbook by Marsha Dunn Klein and Suzanne Evans Morris.
We both brought a copy to the appointment! I actually got it from
Marsha herself during an appointment with her in Tucson, Arizona, back
in 2011. She sold it to me for half price
because it was already opened. :) Anyways, this book is amazing but I
haven't looked at it for a while so it was good to go over it again and I
want to read it again now.
She
also presented a starter formula that they have that works really
well. When getting started, it's best to try one or two new foods at a
time, making sure the tubie child tolerates it. The formula is pretty
simple and easy to follow.
There are also recipes and guidelines in the Homemade Blended Foods book
that are awesome, but more advanced. I have also come up with some
blends that I may modify or simplify depending on how Whitney feels with
them. It's very important to go slow when introducing new foods.
Whitney hasn't show any sign of food allergies yet, but I will always
watch for them. She may not even tolerate it but I'll keep you updated
for sure.
Here are the recipes to my old blends when she only needed 900cals a day:
Blend #1:
two days worth:
1 1/2 cups
Goat Milk
1 cup rolled
oats
1 cup
strawberries (substitute mixed berries)
1 banana
(substitute 1 apple)
1/4 c. dried
cranberries
ABOUT 850
cals in 3 cups
Blend #2 two
days worth:
1 1/2 cups
Goat Milk
1/2 cup dry
quinoa (cooked)
2 c. mixed
veggies (including broc., peas, spinach, carrots, ect.)
1 avocado
ABOUT 950
cals in 3 cups
850 + 950 =
1800cals /2 = 900 cals a day
NOW (at 3 & 4 years old) Whitney needs 1200 cals a day, so the blends have to be at least 30cals an oz.
New Blend
#1:
GRAINS: Brown rice dry baby cereal (6tbsp)
VEGGIES:
sweet potatoes and spinach (4.5oz OR 1/2cup)
FRUIT: Mixed
berries (9oz or 1cup)
MILK: Dry
milk powder (3/4 c)
PROTEIN:
cooked beans (1/4c)
FATS: Flax
Oil (2tbsp)
EXTRAS:
Blackstrap Molasses, probiotic, nutritional yeast,water
New Blend
#2:
GRAINS: Oat dry baby cereal (6tbsp)
VEGGIES: frozen or canned mixed veggies (4.5oz OR 1/2cup)
FRUIT:
Applesauce and Banana (9oz or 1 cup)
MILK: dry
milk powder (3/4cup)
PROTEIN:
pureed chicken (1/4c)
FATS:Coconut Oil (2tbsp)
EXTRAS: Blackstrap Molasses, probiotic, nutritional
yeast, water
I might even add herbs and spices that are healthy and blend well.
Katherine, the GI RD said to use calorie king to look up food calories.
This schedule would be a combo of blended foods and commercial formula.
So if one blend makes one days worth with out formula, I would just
feed it to her over two days.
SCHEDULE:
3 meals of
300 cals each
2 snacks of
150 cals each
OR
5 meals of
240 cals each
EX:
8am 300cals
(10oz) OR 240cals (8oz)
11am 150cals
(5oz) OR 240cals (8oz)
2pm 300cals (10oz)
OR 240cals (8oz)
5pm 150cals (5oz)
OR 240cals (8oz)
8pm 300cals (10oz)
OR 240cals (8oz)
GIVE 2oz
water before and after each meal and snack!!!!!
I really don't think she would be able to handle 10oz at a time. Plus
that's a lot of food for me to be pushing through a syringe. Although
this might be thin enough to go throw the pump, but that's more cleaning
to do. :) Also notice that that schedule is with out a night drip.
Which I have no idea if she will be able to handle that or not either.
But it would be sooo nice to eliminate the night drip. But with her
delayed gastric emptying, this definitely wouldn't work all the time.
Like I said before, it will be a very slow process to work up to.
Whitney would still have to come sit at the table for every meal which
would be great for preparing for CHOC's feeding program and also
transitioning home (hopefully eating a lot more by mouth).
I've been thinking about it a lot and was thinking about how cool it
would be to just throw in the blender what everyone else is having for
meals. Of course that would be a lot of blending and cleaning though.
But if we were having oatmeal and fruit with honey, nuts, and juice,
then I could make a bowl for her too, but instead of her eating it (well I would offer
some) I could puree it and tube feed her it! Or a dinner of chicken,
potatoes, green beans, and milk, save her portion and puree it for her
tubie. I don't know if it would ever come to that but I was just
thinking it would be fun.
I don't really plan on doing a complete BD, just a partial one to
supplement her formula. Her Compleat Pediatric Formula actually
contains chicken, peas, green beans, peaches, and cranberry juice. If
all these fancy blends don't work out, then I still plan on continuing
to do the pre-made baby foods from a pouch. It's super easy and fairly
inexpensive. But I'm very hopeful that this will work for her!
Such great information! I love it when you are able to do the blenderized diet for Whitney. It is so good for her! You always put in the best ingredients! What an awesome mom you are!
ReplyDelete