This is a special guest blog post by Kipp Ellsworth, MS, RD, CSP, CNSC.
Transitioning to a Tube-Feeding Regimen
For the parents of children with a medical condition requiring a feeding tube, making the transition from exclusive oral feeding to dependence on a tube-feeding regimen for their children’s nutrition needs often represents an emotionally wrenching journey. The loss of independence for your child, difficulty in traveling, and perceived loss of pleasure associated with eating all constitute significant obstacles for parents in adjusting to the rigors of a home tube-feeding regimen.
As a clinical nutritionist with twenty years of experience in the pediatric inpatient setting, I’ve witnessed the travails of parents navigating this tumultuous lifestyle change. Indeed, the parental stress experienced during the introductory phase of a child’s tube-feeding regimen is often compounded by the loss of conventional food options and being limited to a standard enteral nutrition (EN) formula, thus transforming a very natural process into what is perceived as a very medical one. Though appreciative of the standardized calorie, protein, vitamin, and mineral content in EN formulas, many parents yearn to provide their children with the best they deserve, often involving a more holistic approach resembling their children’s diets prior to the initiation of the tube-feeding regimen.
To address their concerns, clinicians frequently recommend tube-feeding formulas made with a blend of ingredients from real food such as Nestlé’s Compleat® Pediatric and Compleat® Pediatric Reduced Calorie to great effect. In my experience, transitioning children to the Compleat® Pediatric formulas not only succeeds in incorporating food ingredients into their tube-feeding regimen, but often improves or resolves many of the issues occasionally accompanying the chronic administration of standard EN formula, including diarrhea, constipation, reflux, and retching. Yet, despite the improvements associated with these food ingredient formulas, parents have demonstrated a growing interest in organic whole food options for their tube feeding-dependent children, a quest culminating in the form of blenderized tube feedings.
A New Era in Tube-Feeding Formulas
A blenderized tube feeding (BTF) is defined as the use of blended conventional foods and liquids given directly via the feeding tube. Reasons for the surge in BTF interest among caregivers far transcends the simple pursuit of improvements in feeding intolerance to include addressing potential food allergies (e.g. milk, soy, corn); affording a more active, nurturing role in feeding their children; and integrating personal dietary preferences such as organic and vegan ingredients while avoiding more processed ingredients included in standard formulas. BTFs have perfectly addressed the angst of caregivers in the face of a limited, standard EN formula range of options, providing a wealth of choices for their children and allowing them to experiment with different recipes in the pursuit of optimizing their children’s health and normalizing the tube-feeding process. Only recently has the research literature caught up with this “whole-food” approach, associating the use of BTFs with improvements in gagging, retching, and emesis as compared to standard EN formulas. Most interestingly, some studies have tentatively revealed this decreased GI symptomology as perhaps conducive to increasing oral intake and decreasing dependence on tube feeding, though more studies are indicated to investigate this effect in BTF children with a complex medical history.
The decision to transition a tube-fed child from standard EN formula to a BTF regimen thus appears tentatively supported by the evidence of improved GI symptoms, but this decision must be accompanied by a careful consideration of the risks. First, in contrast to standard EN formulas, preparation of BTF formulas often prove time and labor intensive and the cost of the food ingredients are seldom covered by medical insurance plans. In addition, home BTF regimens initiated without the close supervision of a nutrition support professional could provide inadequate amounts of calories, protein, fluid, vitamins, minerals and electrolytes. The viscosity of BTFs may also prove unsuitable for reliable infusion through feeding tubes, significantly limiting administration options for the caregiver and increasing the risk of chronic tube clogging, further compromising the nutritional status of home BTF patients. Indeed, the challenges to BTF feeding may also occur when a BTF patient is admitted to the hospital; nutrition professionals often struggle to meet the “natural feeding” expectations of caregivers while addressing the potential for the individualization of BTF formula within the context of limited resources
Despite these challenges, nutrition professionals remain committed to assisting caregivers with home BTF implementation and monitoring and endeavoring to develop outpatient resources and programs to support them. But patient and caregiver advocacy also involve presenting options to those who desire food-based tube-feeding regimens, but may not have the time or support required to consistently administer a home BTF regimen. For those caregivers and patients, Nestlé Health Science has introduced a ready-to-feed BTF formula perfectly suited to meet their whole-food feeding preferences.
The Compleat® Pediatric Organic Blends Difference
To address the rapidly evolving BTF feeding landscape, Nestlé Health Science has innovated a unique line of ready-to-feed BTF formulas combining a standardized nutritional content and viscosity with the features most often desired by caregivers interested in BTF, including:
USDA Certified Organic ingredients including grains, fruits and vegetables.
The option of a Plant-Based Blend formula or a meat-containing Chicken-Garden Blend formula.
Prepared exclusively from non-genetically modified organisms (USDA Certified Organic products are non-GMO).
Made without gluten, lactose, dairy, corn or soy ingredients.
No artificial ingredients including colors, flavors, and sweeteners.
Variety of Fruit Purees without Added Sugars
Of particular note, Nestlé Health Science responded to the concerns of caregivers and clinicians regarding the importance of diversification in its whole food-based formula by including fruit purees, adding an important source of Vitamins A and C, potassium, and fiber, and helping to meet the 2-cup equivalents per day of fruit recommended in the Healthy U.S.-Style Eating Pattern at the 2,000-calorie level in the eighth edition (2015-2020) Dietary Guidelines for Americans.
Nestlé’s Compleat® Pediatric Organic Blends products feature a standardized consistency, allowing the caregiver to administer undiluted by syringe via gastrostomy tube with a bore size of at least 12 French. Since Compleat® Organic Blends is formulated with blenderized whole foods, the consistency is thicker than standard tube feeding formulas. If needed, the Healthcare Professional should help determine the amount of water to use for dilution based on the route of administration, the volume of each feeding, the patient’s specific fluid requirements, the patient’s ability to tolerate specific fluid volumes, etc. And, as children grow and their nutrient requirements change, Compleat® Organic Blends is available for those over 13 years.
In conclusion, Nestlé Health Science’s decision to “go back to basics” with its new Compleat® Pediatric Organic Blends products, appears a promising avenue to “moving us forward” by which caregivers and clinicians could foster potential improvements in patient well-being and clinical outcome. I certainly look forward to increasing my use of BTF formulas, such as Compleat® Pediatric Organic Blends in my clinical practice, not only to meet the expectations of caregivers, but also to help promote normal gut physiology and improved clinical outcome across the entire outpatient/inpatient spectrum of care.
This blog is sponsored by Compleat® Organic Blends. The writer received financial support for his time to write this blog, but the content and opinions expressed here are his own. The information in this blog is not a substitute for medical advice.
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