Blended Tube Feeds: How to include BTF into your child's feeding routine
Written By Kate Annat, APD
I'm a registered Paediatric Dietitian with years of experience helping tubies receive their nutritional needs to reach their growth potential. While at the John Radcliffe Hospital in Oxford, I engaged in various specialties including neurodisability and rehabilitation, cardiology, respiratory care, and pediatric intensive care. It was through these experiences that I significantly expanded my skills in caring for children who require tube feeding.
I'm happy to share my knowledge of the blended tube feed (BTF) diet with you here, as I know how challenging it is to feed a tubie and feel like you are giving them your best.
This guide is designed for those wanting to introduce a blenderized diet into the feeding routines of tube fed children. It's aimed at helping those tubies who find standard commercial formulas difficult to tolerate and are suffering unnecessarily.
What is a blended tube feed (BTF)?
A blended tube feed is essentially a diet made from table food, put in a blender, turned into a puree, and fed to your child through a syringe.
When is a blended diet recommended for tubies?
There are a variety of situations where a blended food diet is recommended.
I have witnessed and helped many children who struggled with constipation, vomiting, and reflux due to commercial formulas experience a remarkable turnaround once they switched to a blended diet. Reflux disappears, constipation stops, vomiting ceases, hair grows and they finally gain weight!
If your child has a food allergy, the blended diet can be adapted to accommodate their needs.
A child using a 14Fr tube often benefits more from a blended diet because it lowers the risk of tube blockages.
I truly believe in the power of whole foods for tubies, having witnessed firsthand their positive impact on the lives of children and their families.
How to include blended tube feeds (BTF) into your feeding routine
There are three main ways to include Blended Tube Feeds into the routine and which you incorporate depends on your child's situation. I have worked with patients of all three methods.
-
Add a BTF to a commercial enteral formula.
-
Use the BTF as the main feed, with commercial formula used when travelling or during hospital stays.
-
Use BTF for all tube feeds.
What equipment do I need to make blended tube feeds?
Check out my BTF equipment recommendation page for the brands and types I have used with success.
-
A high-powered blender (>1000 watts)
-
A metal large sieve/strainer
-
Measuring cups, spoons and weighing scales
-
Airtight containers for storage (non-porous plastic or glass) Ice cube trays or containers for freezing
-
Syringes (60mL size with plunger)
-
Insulated bags/ice packs to use when travelling
What food do I use to make a blended tube feed (BTF)?
As a paediatric dietitian I've worked with lots of tubies, introducing them to the blended diet. During this time I've developed a variety of blended tube feed recipes which you can check out below. The general food rules to follow are:
-
A healthy blended diet is made up of protein, healthy fat, carbohydrate, fibre, vitamins, minerals and fluid.
-
Include a variety of foods from each of the core food groups.
Guidelines to help you design a nutritional BTF recipe
When I'm creating my recipes, this is the approach I take. You can make them as a single feed, or for those that prefer, batch make your BTFs.
-
A nutrient rich base – commercial formula, milk or yoghurt
-
Include a protein rich food – meat, fish, eggs, tofu, beans or legumes
-
Use a variety of fruits and vegetables - like you would do with a regular meal, use a few per BTF and switch up the variety from BTF to BTF
-
Use a variety of whole grains – oats, rice, pasta, noodles, wholemeal bread and switch these up, as per the fruit & veg idea
-
Include a small amount of healthy fats – oils, nut butters and avocado
So how does this look for the whole day, by age group? I've created this table you can use as a guide when creating your meal plan for the day. However, each child is unique and together we'll create an individualised plan to satisfy their daily nutritional requirements but to give you the big picture, check out these useful guides - BTF by age and the serving size guide below.
For the downloadable, here's a link to my resources page where you will find all my helpful guides and tips including the this BTF Meal Plan Guide.
Another resource I find useful is this recipe builder: Compleat Blended Diet recipe builder
Tips and helpful hints when making BTF
I've made blended tube feeds many times. These are some tips I discovered along the way, especially when things didn't go so well. I'm happy to share my successes and failures with you...
-
Berries (especially blueberries) fibrous vegetables (string beans, spinach, celery) and flax/chia seeds need to be blended for longer as they have a tendency to stick to the tube.
-
Eggs, spinach and congee must be well cooked before blending.
-
Brown rice blends better than white rice.
-
Acidic foods (tomatoes, oranges, lemons) cause milk to curdle if feed is uncooked.
-
Use a nutrient rich fluid to thin feeds - commercial enteral formula, dairy or alternative milks, rather than water or juice.
-
Foods than thin a BTF - watery vegetables (cucumber, tomato, leafy greens), enzyme containing fruits (paw paw, mango, kiwi, pineapple), oils that are liquid at room temperature (olive oil).
-
Foods that thicken a BTF - rice, pasta, wheat products, oatmeal, bananas, potatoes, amaranth flour, almond/almond meal/almond paste, avocado, sesame seeds/tahini.
-
Add small amounts of liquid at a time to prevent over-diluting the nutritional value of feeds.
-
Steam fresh fruits and vegetables rather than boiling them prior to pureeing to minimise nutrient loss into the water. If boiling, use the cooking water. This liquid retains some of the water-soluble nutrients lost during the boiling process.
How to be food safe when making your BTF
Being food safe is critically important to ensure you aren't introducing anything unwanted through your child's diet, like bacteria. Keep these tips in mind for handling food safely.
-
Start with a clean kitchen and clean equipment.
-
Wash hands with warm soapy water before you start, after touching raw food (such as meat or eggs) and after touching hair or face.
-
Wash fruits/vegetables and the outside of cans/jars of food before use.
-
Use separate cutting boards, knives and utensils (or wash after each use) for fresh produce and raw meat, poultry, or seafood.
-
Cook food thoroughly before use with a method that brings food quickly to a high temperature – boiling, stewing, frying, grilling, baking and roasting are suitable.
-
Avoid using deli meats, soft cheeses, raw foods (e.g. sashimi) in BTF recipes.
-
Use a high-powered blender to reduce risk of tube blockage, this will also reduce the need to dilute the blend
-
For best sanitation, dishwashers should be used for cutting boards, dishes, utensils and equipment. For blenders that are not dishwasher safe, a food safe detergent and hot water should be used.
-
Do not prepare BTF if you are unwell, or for 48 hours after your symptoms disappear.
-
Use rubber gloves if skin has cuts/grazes.
Once I've made the BTF, how do I actually give it to my child?
-
Bring the BTF to room temperature.
-
Increase the volume of each bolus as tolerated
-
Draw BTF into a 60mL syringe. If your BTF does not flow through by gravity, gently push the syringe with small slow pushes.
-
The length of a bolus feed should follow the normal time for a meal (15-30 minutes).
-
If there’s any discomfort during the feed, slow the feed rate by lowering your arm with the syringe or pushing through more slowly.
-
Flush the tube with water after each BTF to reduce risk of tube blockages. The amount of water needed to flush the tube may change depending on your child’s hydration needs which I can help you determine.
How to store BTF
-
BTF can be stored on the top shelf of the fridge (below 5 degrees) for 24 hours.
-
BTF may be frozen (below –18 degrees) for one month.
-
Defrost BTF in a refrigerator or cooler bag with ice bricks, do not defrost on the sink/bench.
-
BTF should be at room temperature at the time of feeding.
-
To warm a blend that has been refrigerated, run the container under warm water and stir well before feeding. If using a microwave, stir adequately to make sure food heats evenly. Make sure the temperature is not too hot to prevent discomfort and burning.
-
BTF cannot be left out for more than 2 hours, which includes warming and feeding time.
-
Once BTF has been warmed, any remaining or unused food must be discarded if not used within 2 hours.
-
Store in a labelled (name, date, ingredients), airtight and reusable container.
-
Use insulated bags (with a cool pack/ice brick) during travel for no longer than 4 hours.
The Blended Diet Toolkit (handout)
From my years of experience, helping families with children on a Blended Diet, I created a comprehensive toolkit. It's a downloadable handout to take with you anywhere. Download it here - The Blended Diet Toolkit, or if you would like to see all the resources I provide, you'll find it on my resources page.
BTF Recipes
I commonly get asked by my families for BTF recipes. Over the years I've gathered a collection of go-to recipes I'd like to share with you. Click on each recipe for all the details. I hope your child enjoys them too.
EGGY PANCAKES
OVERNIGHT OATS
SPAGHETTI BOLOGNESE
PUMPKIN SOUP
QUICK RED LENTIL SOUP
IMMUNITY BOOST BLEND
ALL RECIPES
How can a certified paediatric dietitian help?
I established Cubs because it’s my passion to bring support and help to the many families dealing with feeding challenges. Throughout my years of clinical experience, I’ve helped many children who require tube feeding. I've introduced the blended food diet into many feeding routines, with children of all ages and feeding challenges like allergies and disabilities. I'm here to help support you and your child, with the goal of ensuring your tubie gets the nutritional support they need to thrive.
1
2
3
Book an appointment: in-person or online video call
I’ll meet with you and your child via telehealth or face to face. We’ll discuss your child’s full history from birth until today and answer all your questions.
Get a customised nutrition plan
You’ll receive a nutrition plan that meets your child’s specific needs.
See your child thrive and their confidence grow
As your child’s digestion improves happiness will return to your mealtimes.
FAQ's: Blended tube feeding questions answered.
My child has a food allergy. Do you have BTF recipes I can use?
Yes. We will construct together tailored recipes that suit your tubie.
What foods should be avoided?
This depends on your blender. If you have a high powered blender you can blend whatever you like at free will. Keeping in mind portion sizes of course. If you have a blender that is not so high powered then usually straining foods after blending also helps preventing blockages.
From an avoidance perspective I only opt to avoid certain foods from a thickness perspective. For example bread, pasta, white rice and potato are all foods that thicken with time. So if you want to blend these foods and use straight away go for it. But if you are going to leave it in the fridge overnight or store these foods they tend to thicken with time. I find brown rice and cous cous better substitutes.
Will my child lose weight on a blended diet?
Not at all. In my experience when you start a blended diet you have better tolerance of your tube feeds. Vomitting improves as well as reflux and constipation. As a result of this children often grow better. In the first phases of trialling out blended diet for your family I would calorie and protein count your new bolus feeds. Following this I would discuss in terms of tsp/ tblsp/ cups how to work out the right volumes of foods that will be tailored to your child's needs.
How do I make a blended diet for my child?
There are a few ways you can go about this, and I would discuss this with you in your first consult. Often starting a blended diet feels very overwhelming for families. Often because they have been met with so much resistance or have been made to feel like this is not the right decision for your child. This leads to an amounting anxiety before starting.
In our first consultation I start off with discussing preparations that your family can start straight away. We would calorie count this to be an exact substitute for one of your tube feeds. I think of it as a toe dip into blended diet land to build your confidence. Then the rest is up to your family how you wish to do things.
Some families like to blend what they are cooking for everyone else, which adds some normalcy to feeding your child of course. Other families might batch prep and work out the kcal/mL so they can have the feeds ready to do. I like to educate families on what everyday foods are and their portions so they can work out what to place in blends using cup measurements.
There is also a great tool called Blended Diet Recipe Builder that will calculate and work out the calories and the foods for you.
So basically you can do blended diet however you wish. If you want to go all in we can do full blended diet. Or if you want to make a few feeds blends and then keep the other feeds as formula, you can! It is your family and entirley up to you. I can help with whatever way you wish to feed your child and help you feel confident to manage this yourself at home.
Availability & Location
TUESDAY & WEDNESDAY
Face-to-face & Telehealth
9 am to 4 pm
THURSDAY & FRIDAY
Telehealth ONLY
9 am to 4 pm
Clinic Location:
1 Zeehan Street, Wavell Heights