The Seasoned Expert
Despite her years of experience, Michigan-based registered dietitian Hilarie Geurink remains ever-curious – and hones in on parent intuition.
What’s your first memory of food?
Corn days. I grew up on a farm and my dad had a big garden with lots of ears of corn. We would spend two days as a family husking it, cooking it, bagging it and freezing it for the winter. As a kid I remember thinking, ‘oh my gosh, this is the worst thing ever’. But I grew to appreciate it. Nowadays my husband and I have a big garden and enjoy canning and preserving our own food.
When did you realise that food – and the science behind it – was something you wanted to pursue professionally?
I kind of fell into this career. I actually started out as a nurse and then I went to a fashion school, which wasn’t for me at all. I really like to work with people and I also really like the science behind metabolism and how the human body digests nutrition. Someone suggested I become a dietitian and that’s what I did.
At what point did tube-feeding become an interest?
I was always interested in paediatrics and critical care, but when I found out how little interaction you have with people in that setting, I became more interested in helping families in outpatient clinics.
When I moved home after my internship, there weren’t any openings at the children’s hospital, so I started home visiting with a lot of kids who were tube-fed, which spurred my appreciation for the parent perspective.
Being in homes and seeing how often families were given recommendations that didn’t work for them or align with their goals, that was a game-changer I moved into a hospital setting and worked with thousands of tube-feeding kids. Then in 2021, I started my private service to better support families with blended diets.
When you say you went into people’s homes and saw that tube-feeding wasn’t working, what do you mean?
Well, I’m a big advocate for ‘fed is best’ and ‘all formula fits,’ and using a commercial formula is best for some people. But I would see these kids get sent home on a regimen that wasn’t well tolerated or didn’t make sense for the family. I learned that we need to be more realistic with families about what is actually working for them.
What got me more into real food is the digestive issues that people are having on the commercial formulas. These kids would be going through so many medications and so many procedures for their digestive issues and we’d never address what we’re feeding them. I’d see them after three years of them going through every specialist and they’d still be on the same formula. Why haven’t we tried a real food-based product?
There’s still some resistance to blended feeds in the Australian medical sector. How widely accepted is this diet in the US?
The last clinic I was working in was pro-blends, but I wouldn’t say this diet is widely accepted. It’s not that dietitians and health providers think it’s a bad way to feed, they just don’t have the knowledge and time to figure it out. That’s where I was, too, and that’s what led me to teach myself home blending and start a private practice. Families need way more support than we give them in the clinical setting, which often provides minimal guidance on blending nuances.
In a lot of places I’ve worked we were prioritising numbers over patient care. When you’re pushed to see so many patients it’s a lot easier to prescribe a commercial formula regimen than it is to teach people about blends. It’s a bad cycle and families are accepting a suboptimal state of health for their child because it’s all they’ve ever known.
Your work philosophy is, ‘instead of me telling you what to do, you can tell me what you want to do and I will support you in that’. Where does this approach stem from?
I feel like I can learn just as much from parents as they can learn from me. If not more, honestly. It can be intimidating to put myself out there and say ‘teach me what you know’, because I’m supposed to be the expert, right? But in order to bridge some of these gaps between medical professionals and parents, we really need to work together and learn from each other.
I’m imagining you encounter a lot of emotions from families who are new to this space. How do you support parents who are struggling to come to terms with their child needing to tube-feed?
I think that a lot of the problem is that, often, parents feel unheard. So I try to be a listening ear, take in their perspectives and hold space for how they’re feeling. I also think it’s important for families to realise they aren’t alone in this. That’s why I’ve set up my virtual program, where families are able to connect in weekly group Zoom calls. Through this we build community and learn from each other.
I also love sharing podcasts that help families feel supported, and my favourite one is The Rare Life. That podcast provides solidarity for these families in ways I can’t because I don’t know what it’s like to go through what they’re going through.
Even with professional guidance from someone like you, getting tube-feeding right is still about trial and error – and trying not to freak out – right?
I always say to parents, this is what I think is going to happen, but if it doesn’t, it’s okay. We’ll figure it out together and it’s going to be fine. And as we go, you’ll start to gain confidence because I’m giving you permission to try things, see what works and what doesn’t, and you have my support and guidance along the way.
Hilarie’s six tips for top-notch blends
For nutritional variety, be sure to mix up what foods you’re blending. Rotating through different coloured fruits and vegetables will provide a wide variety of vitamins and minerals. Switch up your protein, grain and healthy fat sources. If your blended meals are limited in variety or you need to avoid whole food groups, you’re likely missing out on important nutrients and supplementation may be needed. Be sure to discuss this with your healthcare team.
Storage containers should be airtight and nonporous to prevent the blended food from spoiling. Deli containers and mason jars are great options for storing blends as they are freezer, microwave and dishwasher safe. I also love deli containers because they stack well in the freezer for optimal storage.
Aim for a thin, pancake-batter consistency with your blended meals. This may seem thick if you’re used to formula, but it’s the higher viscosity (thickness) of blended meals that has been clinically shown to help with digestive issues like reflux and vomiting.
Warming food slightly before feeding can really help with digestion and tolerance. Use a warm-water bath rather than the microwave to avoid uneven heating.
Use syringes with an O-ring silicone plunger rather than a rubber plunger. The O-ring silicone plunger doesn’t wear out or expand with use, making it much easier on your hands to push the food through. My favourite is the Basik O-ring syringe, most families say these last at least four months.
Don’t be afraid to add herbs and spices to your blended food. There are so many health benefits to herbs and spices and they are an easy thing to add to a blend. Try some turmeric for anti-inflammatory benefits, ginger for gastrointestinal issues, or oregano which is high in antioxidants.