Eat Happy!

Eat Happy!

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Sunday, August 4, 2013

A Blended Diet 'How-To'

I have been blending diets off and on for almost two years now. Ian was 100% G-tube fed for about 18 months. He needed to have special formula in order to keep his blood sugar stable. However, he is now using a BD, and fortunately, taking it by mouth. What we do it blend all his meals in a Vitamix and then spoon the purees by mouth. You could do the same thing we do and “tube” the meals.... with a little tweaking. Given the right consistency, you could do the same thing via tube.

..... This is what works for us.... piece together what works for your family.  This is *by no means* a set in stone process!!

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SLOW AND STEADY and CALORIES

I believe that working gradually into the BD is the best way. Fruits and veggies are a good place to begin. Sweet potatoes, carrots, pears, peaches, apples, and most other fruits (except bananas which can be sticky and tricky) are a good starting point. I have found following the calories to be a good guideline of what to feed Ian. I believe breast milk on average is about 21-25 calories per ounce if you are including that in your blends. Think of it as 0.75 or so calories per mL. That's how I used to figure it. The purees in the baby food can be tough. You need to follow the guidelines on the containers. It is also important to find out the caloric needs of your child’s weight and age.

WHAT TO BLEND?

I can tell you this though..... while we were learning about BD at Ian's day-patient eight week feeding therapy program, jarred food is largely water and while the calories are there, the nutritional content is much lower. Although, when needed, it is certainly a good source of nutrition. If you have access to a good blender, blending your own foods will provide better availability in nutrients, and much more options.

When it comes to fruits and veggies, we blend apples, pears, peaches, apricots, mangos, pineapple. sugar snap peas, green beans, carrots, sweet potatoes, mixed veggies of all kinds, and creamed spinach the most. Corn is tough because it is starchy, and berries are tough because of the seeds. It is fun to experiment once you get some basic foods down.

For proteins, entrees, we use frozen meals. That way we know the nutritional content and know he is getting enough protein. We typically take two lean cuisine meals, or one hungry man meal, and throw it into the blender. It gets tough with the consistency, so we usually use broth or bullion to keep it smooth. You can use gravy also........ but I’ll get to that later on with ‘boosting.’ :) Soups also make good blends, and tend to be thinner. I know frozen meals are a little controversial, but they work well for us. We cannot always blend up our meals for Ian. Stomach emptying, food content, and so forth get in the way sometimes. The two lean cuisines, or one hungry man meal, will make *several* meals worth of blend!




Cooked, canned, and steamed foods work *way* better than raw foods. For veggies, we use canned carrots and sweet potatoes. I use GIANT brand steamer bags (not sure which grocery stores you have, but we use the store brand microwave steam veggie bags) for the peas, green beans, mixed veggies, and creamed spinach. Canned veggies tend to make me nauseated, yuckie. We do use canned peaches, pears, apricots, applesauce, and mangos. Fresh produce is hard to blend...... at least for us.


  
We even blend him breakfast entrees. While we don’t use frozen meals, we do use frozen waffles and pancakes, and even breakfast sandwiches. They will blend best with a fruit in them. When we blend pancakes, I usually add applesauce to them the make it smooth. 




What you can also do is blend whatever you are having for dinner. After you introduce foods slowly and individually, you can add them together. Say you are having meatloaf with mashed potatoes and green beans for dinner one night (mmmmmm, now I’m hungry too!) You can put all three of those things in the blender and blend them for her. You could thin it out with juices from meats, broths, or even gravy. Remember to keep the portions correct....... about half the meals veggies or so, then a little bit more protein than starch.

STORAGE

We keep the entrees in the fridge for one week. They do tend to be thicker than the fruits and veggies. We freeze the fruits and veggies. They are usually gone in a month. I freeze them in ice cube trays, which are about 1-1.5 ounces each..... then I bag them by food. You could then mix them anyway you wanted. It’s a little different, but that is the way we do it. Even though Ian is taking them by mouth...... there is no reason you couldn’t do the same thing, blend it the same, prepare it the same, and then push it through a G tube instead of putting it into his/her mouth.

I also save all the juice I don’t need for use in future blends. Having the juices from the canned foods helps with texture, and also gives you the calories from the juice. Soaking in the juice helps keep things smooth. For example, peaches NEVER need any of the juice in the can (they are so juicy all on their own). So, I drain all that juice and save it. I mix all the fruit juices together and all the veggie juices together that I don’t need (which is very very little because veggies are much starchier). I keep them in the fridge for 2-3 week in a bottle and use them for other blends. For example....... If I have a pancake entree in the fridge and it needs thinning before I feed it to him, I add some fruit juice and then mix it up in his bowl. It doesn’t really add calories, and decreases the ratio some, but keeps it smooth. Milk also works very well for this (whole milk has great calories!)

RATIOS

When we feed Ian, we mix about 50/50 fruit or veggie with entree. That way, he is getting a nutritious meal. He uses Nutren Jr formula for dairy. You could always add your breast milk as the dairy.

Another thing worth mentioning (at least I feel it is for us) is ‘boosting.’ I had another BLOG entry that talked about boosting. I’ll send you the link also. But, boosting is adding calories on top of the existing calories. It is a great way to get more bang for your buck if volume is an issue..... like us. You have to make sure the blend isn’t too rich though (thick chocolate flourless waffle dessert with chocolate syrup...... mmmmm, hungry again!) We do what is called 3/4 boosting. There is also 1/2 strength boosting. The ratios are in my other post. Let me know if you have questions about that since it can be confusing.

‘Boosters’ are high calorie foods that can be added to your blends. We use, syrup, jams, jellies, butters, oils, gravies, etc. You can even use powdered formula or formula boosters like Duocal. If stomach emptying is a problem, stay away from large fatty ones, like oils and butters which take a longer time to empty. We find the jams, jellies, preserves work well for the fruits, gravies and syrups for the entrees, and then we use gravy or powdered supplement (Duocal for us) with the veggies. Salad dressings are another good booster, but add LOTS of flavor. We found the amount of salad dressing booster that is added for higher calories, overpowered the veggie flavor hugely! 











Oh, and remember, blends are typically 23 calories per ounce, without any boosting. The 3/4 boosting gets you up to 39 calories per ounce.

TUBING YOUR BLENDS

The blends can be a bit tough to “tube.” But, if it’s done right, it isn’t so bad. It is incredibly tough to get one thin and smooth enough to go through a pump with a bag. Also, leaving them out of the fridge for a long time can ruin them. It is best used with a 60mL syringe and either a right angle Y port extension, or better yet, a thick lumen bolus extension. If you use the Y port right angle extension, you can use either a slip tip or catheter tip 60mL syringe. Not sure how familiar all blend-mommies are with the difference...... but it’s the thin short tip syringe, or the fat tip syringe. The Y port extensions have both opening options. Gravity feeds are also tough with BD since the blends tend to be much thicker then formula or water.

Bolus extension and Y port extension

Slip tip syringe and catheter tip syringe

I found the syringe-push method seems to be most efficient, but also needs the most caution. You can easily push too much too fast. You can always take mini breaks, or feel her belly to see if she is getting full. If stomach emptying is a problem, giving lots of small meals throughout the day will help a lot.

FREE WATER

Most blended diets require extra water boluses.  Purees carry a 50% free water load.  Most formulas are 85% free water.  Follow the guidelines for the recommended amount of free fluid your child needs every day.  Because of Ian's lower GI issues and his visceral hyperalgesia, he needs a whopping 45 ounces worth of "free fluid."  Free fluid is the available amount to the body.  Most children on blended diets, in my experience, need a few ounces of plain water pushed through the tube every day, or even more.

BLENDERS

One final thing...... about a blender. Certainly, use what is available to you. Larger blenders are best for making larger blends... duh. If you try and do small blends in a large blender, it simply flies all over the place! LOL! Personally, I found a Magic Bullet to be a complete waste. The blades were not sharp enough, and it didn’t hold up long enough to be using every day. The Oster and Hamilton Beach ones are pretty good, and reasonably priced. 

Vitamix blenders and Blendtec blenders are awesome! If you have the means..... please..... invest! They have dry and wet containers with great blades designed for each. Then you can mix them together in the wet container. We own a Vitamix. I love that one for many reasons. But, other than the reasons listed above, it has steam vents so I can blend piping hot steamy foods without needing to cool them first. Blending very hot foods without vents creates pressure, risking a pressure release and ‘exploding’ when you open the pitcher (been there, done that, cleaned the place up!) They also have a dial for power, allowing all ranges of speed. The HIGH setting will even heat foods up within 30 seconds, allowing you to blend smoother, and even heat up the blend before feeding it to her (if you would like to avoid microwaving her food). I personally feel that Vitamix would blend-up my iphone if I put it in there!! 



The thing I like best about Vitamix blenders is the nutrient availability. The blender breaks down the cell walls of nutrients, allowing them to be more readily available to the body. Sadly, a regular blender cannot do that.......... but, by all means, a non-Vitamix blender for BD is certainly better than jarred food or formula (other than breast milk).

SUMMATION

I have given you a HUMONGOUS amount of information! Don’t try it all at once. I found having the information available gave me guidelines of what to do when, instead of accomplishing one step, and then going........ now what??? I would start with introducing one food at a time..... then start piecing meals together based on what she has had so far. Certainly keep the breast milk in for dairy and the best nutrition possible if that is on your radar.

Once again, lots of information, and it certainly won’t all pertain to you..... but pick and choose. I believe in giving people options. I hate being TOLD what to do for my son. Gathering all the information and then making the best decision for our family has always been our philosophy. Just believe in what you are doing and know that you are not alone. BD doesn’t have to be *fancy.* You always have time to get fancy later! ;)

2 comments:

  1. Great info! I used a lot of the same 'tricks' when starting my son on a BD (although he did so well, so fast, and I have no patience so I ditched formula within a week!)

    We've gotten to the point now that my son eats what we eat, just healthier versions. If we're grilling steaks, he gets steak...plus things like quinoa, coconut milk, bone broths, swiss chard, kale, avocado (THICK!), and blueberries. I like to think of his tube as a direct line to the best nutrition possible! No other two year old I know is downing beets and flax seed:)

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  2. You are so scientific about it, it's great! I do the same thing for my daughter, who has no tube but who is nearly 3 and is still spoon fed purees. I blend what we eat, depending on what it is - some foods don't blend as well as others, of course. But I do many of the same things as you, and often add a little cream to breakfasts and a scoop of butter to dinners to add calories. Blenders are wonderful things, it's so nice to be able to feed a child who needs the nutrition of a 2 year old, but who only has the eating skills of a baby. I'm glad I don't have to rely on just jarred baby food for her. And I agree with Julie - they can get so much better flavors and foods than without it. My son ate blended (actually I used a baby food grinder with his food and it was somewhat lumpy) foods until he was 4, and at 7 he is such a diverse eater. He likes so many more foods and more adults tastes than his twin who had better eating skills early on, and so choose more of his own foods as a picky toddler. So, for having to have the eating difficulties some of our kiddos have, there is a silver lining :).

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