The Real Deal

Paediatric dietitian Kate Dehlsen shares her thoughts on the burgeoning, blenderised food trend for enteral feeding – and tips for how to get this diet right.

Why are blenderised feeds a point of interest for you?

As a gastroenterology dietitian, I see a lot of kids with reflux, constipation, vomiting and other gastrointestinal issues. I find that for many kids who transition to tube-feeds, their reflux and lower gastrointestinal symptoms can be exacerbated by commercial formula. There is evidence to support a blenderised diet reducing symptoms of reflux, vomiting, retching and diarrhoea – so that’s why I am interested in it.

How restricted are you when it comes to recommending blended feeds for children?

I am bound by my national regulatory body which, at the moment, doesn’t have clear recommendations for dietitians to use and promote blenderised tube-feeding. For this reason, I don’t actively recommend blends. It’s usually either initiated by the parent, which is the case most of the time, or initiated by one of their doctors – a gastroenterologist or a paediatrician. My job is to then support that process and make sure it’s done safely and adequately in terms of nutrition.

Is it tricky when you see families who are struggling with commercial formulas, to not recommend they try blends?

It is hard. What I tend to do is contact the child’s paediatrician or gastroenterologist. It needs to be the parent or doctor making that decision, not me.

So parents who are keen to try blends for their child should talk about it with their paediatrician and gastroenterologist, yeah?

Yes. And if they’re both on board, seek out a dietitian who has experience in blenderised tube-feeding in children, which can be difficult as not all dietitians have experience in this area.

Why’s that?

Dietitians are not typically taught blenderised tube-feeding in their studies so confidence in prescribing it is mixed. There is hesitancy about the safety and nutritional adequacy of blenderised tube-feeding. And there is also a perception that developing a blenderised tube-feeding plan takes a lot longer than using commercial formula. In a way, this makes sense.

You know exactly what’s in a litre of commercial formula, whereas designing recipes can take more time.

For blenderised feeds, I tend to just make sure that each of the five food groups are being met, and monitor the patient’s growth and nutritional bloods. I think that’s the best way. The misconception around blenderised tube- feeding is that it’s a lot more work for the health professionals, but it depends on what approach you’re taking.

Are you excited about the growing trend of families adopting a blenderised diet?

I am. I think all children deserve to have a healthy, balanced diet, no matter what kind of disability they have or might not have. For some children, this might look like a combination of both blended food and commercial formula. It’s whatever works for that individual child. For some parents, it’s not for them and that’s okay. It’s a lot of work. There are really good-quality formulas out there and I support them in this diet for their child. But I am excited about the growing awareness and acceptance of blenderised feeds and I’m happy to support parents on that journey.

Kate shares some practical advice around blended tube-feeds:

What NOT to put down a G-tube

Foods that may contribute to tube blockages include:

Whole nuts and seeds

Things like almonds or walnuts or even chia seeds. You can still use these foods if you can get them in a nut butter form. Or you can use a coffee-bean grinder, and pre-grind nuts and seeds before mixing them through the blend.

Berries with seeds

Strawberries, for example, have tiny little seeds that can be an issue. Some of the families I support still use them, but they make a berry compote and sift all of the seeds out.

Dried fruit

The only tube blockage experienced by one of my patients – that I’m aware of – was caused by a date skin. This is where the blender that you’re using is really important. High-powered blenders pulverise all of the little pieces of food, but if you can’t afford a high-powered blender, use your generic blender and sieve the blend.

Green beans, peas and corn

Like dried dates, the little skin around these food items can be a blocking issue. I don’t discourage using them, but you’re either going to have to use that top-quality blender, or sieve – or do both – to get those pieces out.

Some starchy grains

Depending on the recipe ratio, things like rice, rice cereals and couscous can make a blend become very thick. So if you’re using these starchy grains, you’ve got to get that ratio right.

How to practise food safety in a blenderised- food diet

Literature that discourages blenderised tube-feeding will often say that if you’re giving raw foods straight into the stomach, that’s going to potentially increase the risk of gastroenteritis or food poisoning. But studies have shown there are very minimal cases of food-borne illnesses related to blenderised tube-feeding.

When it comes to food safety in a blenderised diet, it’s really just a matter of following your common sense. If you’re using eggs, make sure they are well-cooked. You’re not going to want to put raw fish through a blend, and you’re going to make sure meats are cooked, like you would in general. You’re not going to give raw meat to a child.

With this in mind, food safety is more about how you’re storing and preparing food rather than the food itself. You want to make sure that once you cook up a batch of food, you cool it down within a couple of hours and then either serve it or freeze it into portions that you can thaw overnight in the fridge to defrost.

If you’re doing something fresh, just throw out whatever you haven’t used by the end of the day.