There are several reasons why children may need enteral tube feeding. They may have a medical condition affecting their airway and/or gastrointestinal tract or refuse food due to sensory or behavioral issues. When a family and care team decide an infant, child, or adolescent requires tube feedings, either a nasal tube is placed or a feeding tube is inserted surgically. The feeds go into the stomach (gastric feeding) or small bowel (jejunal feeding). If long-term (longer than one month) enteral feeding is anticipated, a surgically placed gastrostomy tube (G-tube) into the stomach may be recommended.
There are many commercial formulas from which health care professionals can choose, but there also are a growing number of formulas available that are made from real foods. The real food-based formulas—and the homemade real-food blend formulas—are becoming popular. Some observed advantages of including more real foods in a G-tube regimen are improved tolerance, increased acceptance of food by mouth, decreased cost to the family, better bowel function, and increased feeding enjoyment for the family. Some families, however, have concerns about providing real food in the G-tube such as risk of contamination, clogging of the tube, and increased nutrient variability.
The following are some tips RDs can use when providing care to families who want to use real food in their children’s feeding regimens:
1. Be open to discussing use of real foods in the G-tube. If a family senses that you’re hesitant or judgmental about their choice to incorporate real foods in the G-tube, they may find a less qualified professional to help establish their tube-feeding plan. As an RD, you’re the most qualified professional to ensure this is done safely.
2. Discuss the criteria required for real foods in the G-tube. The American Society for Parenteral and Enteral Nutrition recommends that patients should be able to tolerate bolus feeds, have a mature G-tube track (12 weeks after placement), have a G-tube that is 14 french in size, have no infection in the G-tube site, be medically stable, and have approval from the physician.
3. Work toward using real foods in the G-tube if the child isn’t a candidate. A plan may include working to transition feeds from the small bowel to the stomach, attempting bolus feeds rather than continuous, or changing to a commercially prepared formula that has real foods in the ingredients.
4. Determine the equipment and safety precautions needed to provide safe feeds. A family will need a high-powered blender, proper refrigeration, appropriate measuring cups and spoons, motivation to prepare the recipe daily, a safe water source, and adequate electricity. If a family lacks equipment, you’ll need to assist them in procuring these items. If the family can’t obtain some of these items, they can add commercially prepared baby foods to home tube feedings. Blended tube feeds should be used within 24 hours once prepared, and the blend shouldn’t be left at room temperature for more than two hours. Educate families about proper food safety practices, and refer to the Centers for Disease Control and Prevention recommendations on food safety.
5. Use nutrient analysis software to create a balanced recipe that meets the patient’s needs. The recipe not only needs to meet the patient’s calorie needs but the nutrients also need to be distributed equally between protein, carbohydrate, and fat, as well as contain adequate micronutrients. The recommended distribution of macronutrients is about 15% to 20% protein, 30% to 35% fat, and 45% to 55% carbohydrate.
Providing real food in tube feedings is moving from a trend to common practice. It’s important that RDs support families in the use of home-blended tube feeds as an option that can be nutritionally adequate and safe.
— Amy E. Reed, MS, RD, CSP, LD, has spent her career working in pediatrics. With more than 18 years of pediatric clinical experience, she educates families about important nutrition issues. She’s an active member of the Pediatric Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics, where she serves as the co-chair of member support. To learn more about Amy, visit her blog at www.amyreednutrition.com.