Homemade
Blended Formula Handbook
Table of Contents
- Tube
Feeding are Mealtimes , too
- A
Comparison of Oral and Tube Feeding Meals
- The
Continuum Concept in Homemade Blended Formula
- Our
Perceptions of Mealtimes-The Language We Use
- Why
Homemade Blended Formula?
- A
Dietitian Perspective on Homemade Blended Formula
- A
Pediatrician Perspective on Homemade Blended Formula
- A
Parent’s Perspective-Nourishing and Nurturing
- Is
a Homemade Blended Formula Right for You and Your Child?
- Mealtime
Communication and Homemade Blended Formula
- Mealtime
Socialization and Homemade Blended Formula
- Stress
and Mealtimes
- Creating
a Nourishing Environment for Tube-Fed Meals
- A
Parent’s Perspective-Family Involvement in Homemade Blended
Formulas
- Food
Guidelines
- Homemade
Blended Formula and Hydration
- Ongoing
Dietary Support
- Beginning
a Homemade Blended Formula: Where to Start
- A
Mother’s Perspective-Introducing a Homemade Blended Formula
- Food
Safety, Sanitation, and Storage with Homemade Blended Formula
- Equipment
to Support a Homemade Blended Formula
- Traveling
with Homemade Blended Formula
- A
Parent’s Perspective-A “No Frills” Approach
- A
Parent’s Perspective- A “From Scratch” Approach
- Anatomy
of a Recipe
- Core
Guidelines for a Homemade Blended Formula
- Preparation
Tips from Parents
- Constipation
and Homemade Blended Formulas
- Special
Diets
- A
Mother’s Perspective-A Child’s Special Dietary Needs
- Vegetarian
Children
- Our
Vegetarian Experience
- Supporting
Parents Who Choose a Homemade Blended Formula
- Frequently
Asked Questions
- Commercial
Formula Coverage
Appendices
- Tube
Feeding Glossary
- Food
Sources of Calories
- Food
Sources of Proteins
- Food
Sources of Fats
- Food
Sources of Dietary Fiber
- Food
Sources of Vitamin Chart
- Food
Sources of Vitamin C
- Food
Sources of Vitamin A
- Food
Sources of Vitamin E
- Food
Sources of Vitamin B12
- Mineral
Chart
- Food
Sources of Iron
- Food
Sources of Magnesium
- Food
Sources of Potassium
- Food
Sources of Calcium
- Food
Sources of Milk and Milk Substitutes
- Food
Sources of Common Food Allergies and Intolerances
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Homemade
Blended Formula Handbook
Introduction
by Marsha Dunn Klein, MEd, OTR/L and Suzanne Evans Morris, PhD,
CCC-SLP
(Reprinted with permission from Mealtime Notions,
LLCand Marsha Dunn Klein and Suzanne Evans Morris)
Many families
who are providing tube feedings for their children have asked,
“Why can’t I feed this child the nutrition I feed
my other children?” or “What can I offer my child
besides the same formula every day?” or “How would
I go about providing real blended food through the tube?”
or “Can I still use the commercial formula and just add
a little food?” or “Where would I start”?
These families
have often asked dietitians, pediatricians and other feeding team
members these questions, only to have them admit to having little
or no experience with blended foods in tube feedings. Much to
the frustration of families, many of these professionals have
asked them, “Why would you want to offer something besides
commercial formula?” Some professionals have said, “Well,
I’ve never had anyone ask that question, but let’s
learn together.” This handbook is for them, all of them:
the families who ask “why?” “how?” and
“what?” and the professionals who have limited experiences
and want to learn. It provides a starting point for making homemade
blended formulas and a sharing of information, based on what we
already know about feeding children. It incorporates what we know
about mealtime experiences and what helps children grow. It combines
this knowledge with the experiences of parents and other professionals
who have written these chapters.
What
is homemade blended formula?
Historically, these types of tube feeding formulas have been called
“blender feedings,” “blenderized formula,”
or “blenderized tube feedings.” We have added the
word “homemade” to celebrate the personal and nurturing
nature of the preparation. We define homemade blended formula
as any formula that a parent makes that modifies a standard formula
with “real “foods. It could be a commercial formula
with a small amount of baby food fruit or vegetable added, or
three meals a day of blended food with commercial formula at night,
or a complete diet of homemade blended foods, or many options
in between. We would have preferred to title the book “Homemade
Blended Meals” to remind readers that tube feedings are
mealtimes too. However, “Homemade Blended Formula”
clarifies that the book is directed towards the needs of parents
and professionals who share the lives of tube-fed children.
Historical
perspective
Tube feedings have been around in some form for a long time. The
use of gastrostomy tubes, knowledge of the digestive system and
nutrition, and the technology of tube feedings has developed over
centuries. In the 60s and early 70s, when many of us began supporting
families of tube-fed children, there were far fewer tubes, so
our experience with tube feedings was limited. Only the sickest
children received supplemental feedings. Tubes were predominantly
limited to larger catheter tubes. Infants received tube feedings
with their infant formulas. However, as they grew, their parents
added baby foods to the formula or pureed family foods and did
the best they could to get the food through the tube. Our collective
experience was predominantly “blenderized feedings.”
By the mid
1970s, formula companies developed specialized tube formulas based
on detailed nutritional research, which provided a better understanding
of micronutrients and total nutritional daily requirements. Families
moved from blending table foods to the use of commercial formulas.
These formulas became an easier option for families. Dietitians
and physicians supported the use of these formulas because they
offered nutrition based on the newest research. They knew just
how many calories, macronutrients and micronutrients the child
was receiving. It was easily quantifiable, very portable, pasteurized
and balanced. Families were sent home with cases of formula, a
specific time schedule, and a prescribed number of ounces per
feeding. Tube feedings often became just one more procedure required
of parents when their MEdically fragile children returned home
from the hospital. The tube feeding process and its vocabulary
of doses and ounces and mls or ccs inadvertently emphasized the
MEdical nature of nutrition and increased the separation from
the family meal and the feeding relationship that parents dreamt
of for their children.
Today, technology
has greatly changed and made tube feedings much easier for children
and their families. They’re more portable, more efficient
and less restrictive. We also have become a more health-conscious
and better-inforMEd society. We’re learning daily from research
literature and the popular press about foods we should add or
remove from our diets. We’re increasing our understanding
of the importance of diversified diets as the best way to provide
the micronutrients needed for optimum health. Parents are rightfully
asking if one formula, one diet or one recipe can provide all
the nutritional variation needed to maximize nutrition, health
and growth for their tube-fed children.
In addition
many parents are asking about homemade blended formulas as a way
to empower themselves in making personal choices about foods.
Many parents report that preparing homemade blended formulas gives
them more control in their children’s growth and feeding,
and allows them to nurture their tube-fed children with food as
they would orally fed children.
In this handbook,
we consider how to integrate the best of past technologies and
concepts with the present, to create a new present and future
for tube-fed children and their families. We’d like to help
families and professionals think about the meaning of tube feedings
and find ways to integrate them into the family mealtime.
Research
Very few published articles describe the “hows” and
“whys” of homemade blended formulas. By contrast,
a great deal has been researched about healthy nutrition for orally
fed children.
We have a
large amount of information about what to feed children, how much
to feed them at different ages, what nutrients are needed for
optimal growth and how to interact with children at mealtimes.
There’s limited research into how to translate this information
for tube-fed children and their nutrition, and it’s dominated
by information about commercial formulas and their benefits.
Commercial
formula need not be the only option. Many parents are feeding
their children homemade blended formula and have had very positive
experiences. Instead of being written up in scientific journals,
these positive experiences have been shared anecdotally through
professional discussions and from parent to parent by phone, Internet
mailing lists and online chat rooms. We need to encourage and
support research about homemade blended formulas. Historically,
good research is designed from a broad collection of personal
and clinical experiences, which enables researchers to ask meaningful
questions.
We’ve
seen the changes that homemade blended formulas have made for
many children and their families. In this handbook, we’ve
included input from families in the United States, Canada, England
and Australia, obtained from professional clinical experiences,
informal parent questionnaires and feeding support groups on the
Internet. It’s hoped that the experiences and questions
raised in this handbook will inspire researchers to ask those
meaningful questions.
Team
Approach
It’s our belief and experience that supporting families
in the decision-making process necessary for making homemade blended
formulas requires a team approach. The parent is the leader of
the team. We trust the instincts and knowledge of parents as they
make everyday decisions about feeding their orally fed children.
And we need to trust parents of tube-fed children to make nutritional
decisions for their children.
The special
considerations of tube feeding technology and special diets, and
the translation of oral feeding knowledge to tube feeding, often
requires additional team support. When parents are considering
serving homemade blended formula, it’s very important to
work closely with their children’s health care team, starting
with the primary care physician.
To reflect
that team support in this guide, in addition to our own years
of clinical experiences as an occupational therapist and speech-language
pathologist, we’ve compiled and edited articles from dietitians,
physicians, nurses, and most importantly, parents. Parents have
written articles and given input every step along the way. They’ve
suggested topics, provided information, reviewed drafts and given
feedback.
It’s
our intent to provide information about feeding children, education
about homemade blended formulas, guidelines for introducing blended
foods through the tube and some sample recipes. We’ll share
parent and professional experiences. But mealtimes are personal
in nature, whether they’re oral or tube mealtimes. What
works for one family and one child may not work well for another
family and child. We include guidelines for providing blended
meals through a tube, but more importantly we share ways to listen
to your child and move forward in offering food as your child
indicates readiness. Each child and family is different;
The choices
families make in their journeys with tube feeding reflect their
family circumstances and dynamics, and their children’s
specific nutritional needs. No equipment or diet defines what
makes mealtimes work. The essence of the tube-feeding mealtime
lies in the bigger picture. Positive and successful mealtimes
are defined by how tube feedings are offered, how blended foods
are introduced, how cues are read, and how we listen to children.
It’s
not our perspective that every child who receives tube feedings
should be given a homemade blended formula. Rather, it’s
our intent to offer information so parents and professionals can
make inforMEd choices for feeding children who receive nutrition
through a feeding tube.
Back
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© 2007
by Mealtime Notions, LLC Ph: (520) 829-9635. Homemade Blended Formula
Handbook/Klein and Morris. This page may be reproduced for instructional
use. This handbook is for educational purposes and should not
replace the advice of the physician caring for each child.
