This is a complex topic, particularly for families with children who require tube feeding. Tube feeding is necessary when a child cannot consume enough nutrition orally and requires assistance to meet their dietary needs. There are two main types of tube feeding:
- Enteral feeding – where nutrition is delivered into the digestive system.
- Parenteral feeding – where nutrition is delivered directly into the bloodstream via a vein.
For this blog post, I will focus specifically on enteral feeding, which involves delivering nutrition through a tube into the digestive tract. This may be done through a nasogastric (NG) tube, which passes through the nose into the stomach, or a gastrostomy tube (PEG/PEJ), which is surgically placed directly into the stomach or small intestine. Note: Children with PEJ (jejunostomies) are generally not considered for blenderised tube feeding.
Photo of a neonate with NG tube. Note: babies under 6 months will not be considered for blenderised tube feeds as they should be on expressed breast milk or formula.
Previous Perspective on Blenderised Tube Feeding
When I first started working as a paediatric dietitian in 2011, blenderised tube feeding (BTF) was largely frowned upon by health professionals. Families were encouraged to use commercial formula feeds, which were considered safer. The main concerns with BTF were:
- Risk of contamination – Most children requiring tube feeding often have underlying medical conditions and likely to have weakened immunity. These children are generally more vulnerable to infections than the average healthy child as they are likely to have additional health challenges: such as limited mobility, difficulty with communication, or compromised immune function. Hence there is a big focus around strict food hygiene practices. Given home-prepared feeds can become contaminated, a child is at risk of foodborne illnesses such as food poisoning or gastroenteritis, increasing the risk of dehydration, requiring urgent medical care.
- Risk of tube blockages – Thick or improperly blended foods can clog feeding tubes, which can be problematic. A blocked nasogastric (NG) tube can often be replaced by a trained carer or by a medical professional such as a trained nurse or doctor in a medical setting. However, a blocked PEG/PEJ tube is far more complex to manage as this involves a hospital visit to attempt unblocking or even replacing the tube. With a blocked PEG/PEJ tube, the child may temporarily lose access to nutrition and hydration, increasing the risk of malnutrition and dehydration. This is especially true for children who cannot manage any food orally, where they can be dehydrated and will require emergency medical intervention.
- Risk of nutritional inadequacy – Homemade blenderised feeds may not always meet a child’s nutritional requirements, particularly if families do not have regular contact with a healthcare provider. Children who require tube feeding often have unique medical and nutritional needs, which differ from those of a healthy child. Commercial formulas usually are prescribed by a health practitioner, and are designed to be nutritionally complete, ensuring adequate intake of macronutrients, vitamins, and minerals.
The Current Perspective on Blenderised Tube Feeding
Today, BTF is no longer as controversial. Instead, it is considered a viable option for families, provided they have ongoing and consistent support from healthcare professionals. Many families have expressed a preference for BTF for several reasons:
- It feels more ‘normal’ – Parents feel their child appears less “sick” when they can consume food similar to the rest of the family. This can be particularly important when there are siblings in the household who will inevitably question why their brother or sister cannot have the same food as the family.
- Greater control and involvement – Many families feel more empowered when they can prepare their child’s meals themselves. Food is often seen as a way to express love and care, and some parents feel that relying solely on commercial formulas takes away this opportunity.
- Better tolerance and improved symptoms – Some families report that their child experiences fewer gastrointestinal issues (such as vomiting, reflux, or constipation) on BTF compared to commercial formulas. Some also notice improved mood and behaviour.
Important Considerations for Families Choosing Blenderised Tube Feeding
For families considering BTF, it is essential to work closely with healthcare professionals and ensure key safety measures are in place:
- Child is deemed safe to have Blenderised Tube Feeding by a medical professional
- Ensuring the feed is the correct consistency to prevent tube blockages.
- Learning proper tube care and cleaning practices.
- Flushing the tube correctly to keep it clean and functional.
- Following strict food hygiene practices to minimise the risk of foodborne illnesses.
- Regular nutritional assessments to ensure the child is meeting their dietary needs, ideally every six to twelve months, or more if your child is unwell.
- Monitoring fluid intake to prevent dehydration.
- Ensuring adequate vitamin and micronutrient intake through the blenderised feeds.
- Tracking your child’s growth at least twice a year to ensure they are thriving.
- Monitoring gastrointestinal health: keeping track of symptoms such as vomiting, pain, or changes in bowel habits.
Final Thoughts
There are many resources available for families interested in BTF, but it is crucial to rely on credible sources and seek guidance from qualified healthcare professionals. If you are considering blenderised tube feeding for your child, I highly encourage you to read the articles at the end of this post and consult with your dietitian, doctor, or other healthcare providers to determine if BTF is a safe and suitable option for your family.
