By Whitney Christie, MS, RD, CSO, CNSC, FAND

Blenderized tube feeding can be a worthwhile method to explore for those doing home tube feedings. Studies have shown that blenderized tube feedings result in less gagging/retching, digestive improvements and diversifying the gut microbiome^1-3. Using real food through a feeding tube has also been shown to decrease oral aversion, increase weight and lessen hospitalization². Other benefits include offering a way to increase mealtime connections, emotional support, control of food choices and participation in preparation of meals.

Many people think blenderized tube feeding looks and seems hard (initially, these were my thoughts too). Although blenderized tube feeding may require some meal planning and preparation, it has its benefits. Commercial blenderized tube feeding can also simplify the process. If you haven’t yet heard of or tried blenderized feedings, here are a few things to know and tips on mastering the art of putting real food through your feeding tube.

What is Blenderized Tube Feeding?

In short, blenderized tube feeding involves taking real foods and using them through a feeding tube, either as a supplement to your nutrition you take by mouth or as a way to provide all of your nutrition. Blenderized feeding in its simplest form can involve putting fruit juice down your tube or you can use a blender to prepare your daily meals from one meal a day to all meals during any given day. Blenderized tube feeding can go through G-tubes, J-tubes and even NG tubes. Always discuss administration with your healthcare provider, and need for additional vitamin/mineral supplementation as needed.

How to Get Started

If you’re worried about clogging your feeding tube, you aren’t alone. This is a valid concern for someone thinking about blenderized tube feeding, but can be solved through proper technique, administration methods, and G-tube care. In order to start blenderized feedings, a 14-French Feeding tube is recommended, although tubes with French size as small as 10-French have been used for blenderized tube feeding. Medications, particle size of the food blend, and flushing technique may also play a factor in feeding tube clogs¹.

Equipment Needs

Knowing what equipment to use can also help with being successful with putting real food through your feeding tube. It can be difficult to do a syringe feeding using a traditional gravity method with real food feedings. A manual push method using a feeding syringe can be another option. O-ring syringes are helpful for tube feeding real food blends when other plunger types may stick. Lubricate the feeding syringe with olive oil or butter to help make pushing the blend easier. If you are packing your lunch, traveling to multiple doctors visits or just want to make it easier on yourself at home, consider drawing up blenderized feeding in several syringes for a quicker, less time-consuming (and possibly messy) feed. For easy transport, throw them in a bookbag with an ice pack and go.

Gravity Bags

For those using gravity bags, you will need to request large bore gravity bags. Some find challenges even with large bore gravity feeding bags and often require a thinner blend (which may mean using lots of fluid to thin out the mixture). Dietitians can be a great resource to help troubleshoot tube feeding and review any adjustments you’ve made in things like fluids and provide input (or another perspective) if needed. Blenderized tube feeding is a process that you are not going to be perfect at initially. It takes time and often trial and error to find a system and routine that works for you. DMEs may also provide these for you¹.

Bolee® Bag

Bolee bags are a newer, innovative feeding system where reusable tube feeding pouches help administer feedings (you can even obtain samples of them if you inquire with your healthcare provider). The pouches can be used multiple times (up to 15 uses). I often have patients who prefer to use these when they have administration challenges with gravity bag feeding their blends.

Button or Low Profile Feeding Tubes

For those with a button tube, straight bolus extension sets are needed¹. Talk to your homecare or the company that provides your tube feeding about this. If you are using a tube feeding pump, it is best to discuss with your nutrition support professional or homecare company. Blenderized tube feedings can be administered using a tube feeding pump but there may be adjustments that are needed with either the tube feeding pump or the blenderized product that are necessary.

Blender Considerations

Now let’s talk about the fun part…. making that blend! Making or mixing your blend will involve the use of a blender. Blenders range from professional, to jug or wand style. Professional blenders are often stronger with a high-powered motor, extended warranty and may work better for those requiring blenderized tube feedings for a longer length of time. A typical blend takes 3-6 minutes of blending time (or more if you want to decrease particle size of the blend)¹.

Types of Blenderized Tube Feedings: Homemade Versus Commercial

There are various ways of utilizing blenderized tube feeding into your daily routine. Homemade and commercial preparations each have various benefits. It is also important to remember that you can also do both homemade and commercial blends together. Your nutrition doesn’t have to be limited to one type of blenderized feed (people who normally eat food by mouth often do not have the same exact foods at the same time every day). This is one of the beauties of using blenderized products as they offer more variety and options than traditional formulas.

Homemade formulas can be done on the spot and a blender can be used at the time of meal prep. Some prefer to make large batches ahead of time and use them in the future, following food safety practices. Tips for homemade blenderized feeds would be to consider having airtight containers for freezing, freezer space and refrigerator space for thawing. A combination of these methods can also happen.

Commercial products offer an easy, convenient way to start the blended tube feeding journey. These are formulas manufactured with food ingredients or pureed foods that may or may not have added vitamins and minerals. You will also need to have adequate space to store these (most homecare companies send a month’s worth of formulas at a time). Insurance is variable for commercial blenderized tube feedings so talk with your durable medical equipment (DME)/homecare or infusion company as additional documentation may be needed for coverage or what blenderized products they have that might be an option for you. A registered dietitian can also help navigate this with you. Nutricia Navigator is a helpful product coverage and access assistance program, which you may contact for free personalized one-on-one support in obtaining Real Food Blends meals. Real Food Blends® offers 100% real food meals with no synthetic ingredients, and most closely mimics homemade blenderized tube feeding compared to other blenderized enteral products.

If making homemade blends, foods that increase the risk of tube clogging include white pasta, white rice, breads, muffins and bagels, uncooked protein sources, meats, seafood, beans/legumes, eggs, flaxseed, olives, celery, string beans, and fruits with skins¹.

Sieving is a process where utensils (typically with a mesh/wire strainer (or cheesecloth) separate coarse food particles, separating solids from liquids or reducing soft solids into a pump.  Sieving can take away a significant portion of the nutritional value of a food so limit using a sieve for removing seeds and stems¹.

Hang Time

You want to discard any commercial product within 24 hours after opening and hang time for commercial products varies depending on the product.

For homemade blends, hang time is no greater than 2 hours. And it is recommended to discard blends after 3-4 days if they are not frozen. Make sure you are freezing prepared blenderized tube feeding within 24 hours of making¹.

In conclusion, blenderized feeding can seem intimidating at first but hopefully some of these pointers can make the journey a little easier for you and allow you to experience a world of possibilities and benefits. Always work with your healthcare professional when making changes to your tube feeding plan at home.

Whitney Christie is a consultant for Nutricia North America and has been compensated to write this blog post.

References:

1. Epp L, Blackmer A, Church A, et al. Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition. Nutr Clin Pract. 2023;38(6):1190-1219. doi:10.1002/ncp.11055
2. Schmitz ÉPCR, Silva ECD, Lins Filho OL, Antunes MMC, Brandt KG. Blenderized tube feeding for children: an integrative review. Rev Paul Pediatr. 2021;40:e2020419. Published 2021 Sep 1. doi:10.1590/1984-0462/2022/40/2020419
3. Desai et al. Real-World Evidence on Clinical and Health Economic Outcomes among Adults Patients in Post-Acute Care Receiving Commercial Blenderized Tube Feeding Formulas. JPEN. 2023; 47(52):S104.

By Sharon Weston, MS, RD, LDN, CSP, FAND

Blenderized tube feeding (BTF) is becoming an increasingly popular choice among families and individuals seeking a more natural, personalized approach to enteral nutrition. Whether you’re looking to transition from standard formulas or supplement with real food, starting the conversation with your healthcare provider (HCP) is a critical first step. Some patients or caretakers may feel unsure about how to bring up blenderized tube feeding, what questions to ask, or how to respond to concerns. Learning some tips and practical strategies to help prepare, communicate effectively, and work collaboratively with your healthcare team can lead to a successful transition to blended feeds.

Blenderized tube feeding may offer several potential benefits, such as:

• Improved digestion and tolerance
• Reduced reflux, gagging, and constipation
• Greater inclusion of real, whole foods
• Opportunities to tailor blends to personal, cultural, or medical needs
• A more natural feeding experience for patients and caregivers

Despite these advantages, blended tube feeding is still unfamiliar territory for some healthcare providers, especially in clinical settings where commercial formula is prevelant. That’s why being prepared, respectful, and collaborative in your approach can help open the door to supportive, informed discussions.

How to Talk to Your Healthcare Provider About Starting Blenderized Tube Feeding:

1. Clarify Your Reasons for Wanting Blended Feeds

Before your appointment, take time to reflect on why you’re interested in blenderized tube feeding. Are you seeing issues with current formulas, like constipation or reflux? Do you value feeding with real food for emotional, cultural, or philosophical reasons? Are you hoping to reduce synthetic ingredients or additives?

Write down 2–3 main points. This helps you start the conversation with clarity and confidence.

Example talking points:

• “My child has ongoing GI symptoms on formula, and I’ve read that blenderized tube feeding might help with tolerance.”
• “We’re looking for a more natural approach to tube feeding and feel that real food might align better with our family’s values.”
• “We want to include foods that reflect our cultural meals, and blenderized feeds might offer that flexibility.”

2. Learn the Basics

Doing your homework shows your healthcare provider that you’re serious, informed, and open to guidance. This also helps you respond to common concerns such as safety, nutrition adequacy, or risk of tube clogging.

Key points to know:

• Blenderized tube feeding can be delivered via a G-tube (14 Fr or larger) using syringe, gravity, or pump methods.
• Recipes can be created or reviewed by a dietitian to ensure they meet all nutritional needs.
• Commercially prepared BTF (CBTF) products are available and shelf stable. Real Food Blends® is a commercial option that offers 100% real food meals with no synthetic ingredients.
• High-powered blenders and proper straining reduce the risk of clogs.
• Blends can be made safely with proper food handling and hygiene practices.

3. Collaboration is Key

Healthcare providers may feel hesitant if they’re unfamiliar with blended feeds but framing the conversation as a partnership rather than a confrontation helps build trust. Rather than saying “We’re switching to blended tube feeding,” try:

Collaborative phrasing:

• “We’d love your guidance as we explore whether blended tube feeding is right for us.”
• “We’re interested in trying blenderized tube feeding, even just one meal a day to start. Could we work with a dietitian on this?”
• “Would it be possible to use a combination of standard formula and blenderized tube feeding to help with some of the symptoms we’re seeing?”

This approach invites the healthcare provider to be part of the solution and provides room for shared decision-making.

4. Involve a Registered Dietitian Early

One of the strongest ways to ensure success is to request or include a dietitian who is familiar with blenderized tube feeding in the process. Dietitians can:

• Help assess nutritional needs
• Create or evaluate blenderized diet recipes
• Recommend safe multivitamin/mineral additions
• Guide proper food handling
• Support gradual transitions

Let your healthcare provider know you’re committed to doing this the right way.

Phrase to use:
“We’d like to make sure we’re covering all nutrition bases.  Can we schedule time with a dietitian who is familiar with blenderized tube feeding to help us build a safe plan?”

5. Start Small: Propose a Trial or Hybrid Approach

You don’t need to overhaul everything at once. In fact, starting slowly often builds trust and allows time to observe tolerance.  Start with one blended feed per day and the rest standard formula. Monitor for improvements in energy, digestion, or mood.  This hybrid approach allows flexibility and helps healthcare providers feel more comfortable with the change.

Suggestion to offer:
“Could we try just one blenderized meal a day, and keep the rest of the feeds as is? That way we can monitor tolerance and make adjustments.”

6. Reassure Food Safety Measures

Some providers are concerned about food safety, microbial risk, or inconsistent nutrients. These concerns are valid but manageable with proper precautions.

Let your HCP know you plan to:

• Use a high-powered blender
• Store prepared blends safely (refrigerate up to 24 hours, freeze portions)
• Follow food safety precautions, cleanliness, safe thawing and reheating practices
• Strain blends as needed for smoother consistency
• Add a multivitamin or electrolyte supplement as needed

You can even bring a sample commercial blenderized tube feeding product to your appointment to show what’s available and how easy it is to use.

7. Respect Differences

Some healthcare providers may still be hesitant and that’s okay. Rather than seeing it as a rejection, treat it as the beginning of an ongoing conversation. You can always revisit the topic later with more information or results from your trial.  If necessary, seek a second opinion or connect with a dietitian who has experience with blended tube feeding. Support groups and online communities can also provide insight and shared experiences that empower you.

Starting blenderized tube feeding is a personal decision that should be respected and supported. As a patient or caregiver, you have the right to ask questions, explore alternatives, and advocate for the best care, including nutrition that aligns with your values and needs. Whether you go fully homemade, choose commercial blended feeds, or use a combination, starting the journey begins with one important conversation.  Many families have successfully made the transition to blenderized tube feeding and found it empowering. Like any change, it takes time, learning, and support but with the right tools and the right team, it’s very achievable.

Sharon Weston is a consultant for Nutricia North America and has been compensated to write this blog post.

Resources:

The Oley Foundation:  https://oley.org/page/CaregiverParents

NASPGHAN GIKids.org:  https://gikids.org/digestive-topics/blenderized-tube-feeding/

NASGPHAN Culinary Medicine Webinar Series:  Blenderized Tube Feedings

https://gikids.org/food-as-medicine/

By Hilarie Geurink, RD, CSP

If you or your child uses a feeding tube and blends some or all of your meals, traveling can feel extra overwhelming. But with the right planning and a few smart tools, it’s more doable than most people expect.

From packing meals safely to getting through airport security or figuring out how to blend on the go, this guide walks you through the most common challenges.

You’ll also hear from real families who’ve done it, so you can see exactly how others make travel work with a feeding tube and blended diet.

Packing Your Medical and Tube Feeding Supplies

This is probably obvious, but it’s important. Start planning your packing list early. Create a checklist at least a couple weeks before your trip and share it with other caregivers. Some families use shared notes apps, others like to use google docs. This gives you time to notice anything you use daily that didn’t make the list at first.

It’s also important to keep things separate and accessible. Many families like packing cubes or even those over-the-door shoe organizers to keep supplies tidy and easy to find. You’ll also want to store medical supplies in a separate bag, that way it’s easier to find what you need, when you need it.

One last thing to consider when packing is when you get your regular medical supply shipment.

Sometimes that doesn’t line up with your travel schedule. If you’re expecting a shipment after you leave, your DME or care team may be able to adjust the timing or ship to your destination. If not, start setting extras aside as early as possible.

Planning Your Blended Meals Based on Your Trip Length and Style

After you get a good handle on your supplies and are feeling more organized, start to think about your blended meals and how they’ll fit into your travel plans.

There’s no one right way to do it, families find all kinds of creative ways to make it work!

But it’s important to be realistic about what feels doable, and prioritize whatever helps your family enjoy the trip.

Here are some things to consider:

1. How long will you be gone?
2. Will you be flying, driving, or taking another form of travel?
3. Do you want to bring your blender and prep meals during the trip? (And don’t feel guilty if you don’t, most people eat out on vacation for a reason!)
4. Will you have access to a kitchen, fridge, or freezer?
5. Will you have access to grocery stores or food delivery at your destination?

And to help you start thinking through your plan, here are the options I see families using the most:

Option 1: Blend everything ahead of time

• Pre-portion and freeze meals at home. Pack frozen meals in a cooler with long-lasting ice packs. Bring thawed meals for the travel day.

Option 2: Blend some meals + blend at your destination

• Bring blends for the travel day plus 1–2 more days (so you don’t have to blend right away) and blend fresh once you arrive and are settled.

Option 3: Use commercial blends during travel day, pre-packed homemade blends on arrival

• Bring commercial blends for travel days and pack frozen homemade blends to use when you get there.

Option 4: Use a mix of commercial blends, and blend at destination when able

• Use commercial blends for travel days or when you’re out and about, and homemade blends when you have more time or access to a kitchen.

Option 5: Use only commercial blends for the entire trip

• This is especially helpful when you’re short on time, staying somewhere without a kitchen, or just want to simplify your travel.
• Real Food Blends® is a commercial option made from 100% real food and no synthetic ingredients, and is the closest to homemade blenderized tube feeding compared to other blenderized enteral formulas.

How Real Families Travel with a Blended Diet

Not sure how this might play out in real life? Here’s exactly how some families packed, planned, and made it work:

Example 1). We packed meals and blended fresh once we arrived.

“We normally use mason jars but use the disposable deli soup containers while traveling. Then I blend once we arrive, and re-use the plastic containers until the end of the trip. We pack our high-powered blender in the checked luggage, and also basic measuring supplies, and then always stay somewhere with an in-room kitchen or Airbnb with full kitchen.”

Example 2). We blended everything ahead of time.

“We’ve traveled several times for a week with my daughter. I blend an entire week’s worth of food and separate into individual pouches per meal. I use the Baby Brezza® reusable pouches and freeze them. When we fly, we put them all in a backpack cooler with ice packs and everything stays frozen!”

Example 3). We brought both homemade blends and formula for backup.

“We flew recently with a week’s worth in a cooler bag (all going in frozen as 6 oz portions in breastmilk bags). The food for day was thawed, portioned in 60 mL syringes, and kept in a smaller, soft-sided cooler. I also brought a week’s worth of Real Food Blends® in a carry on just in case. Total travel time was ~ 8-10 hrs. I knew we could get more ice on the plane or before the drive but we didn’t need to. And the flight attendants gave us hot water in a cup to warm up the food for us in the air.”

Example 4). We relied on commercial blends this time.

“Most of the time I make all of my daughter’s food, but on long appointment days or really busy weeks, we use commercial blends that are covered by insurance. She never used to do well on them by themselves, but now that we mix in home blends, she’s totally fine for few days to a week. It made things so much easier. We didn’t have to worry about groceries, prepping food, or being back at a certain time to blend.”

Hopefully these examples help you picture what might work best for your own trip. But just know, there is no one right way. The key is finding a plan that feels manageable for your family.

Final Tube Feeding Travel Tips: What Families Would Want You to Know

After working with many families who travel, I’ve picked up on some of the little things that can make a big difference. These aren’t always in the packing list, but they’re the tips families say they’re so glad they knew beforehand.

1. Test your cooler ahead of time.
   
   Pack it with ice packs and meals to see how it holds up. Some coolers sweat more than others, which can be a mess. Find one that doesn’t leak or drip.
2. Give yourself extra time at the airport and consider TSA Cares.
   
   Security will take longer when you’re traveling with feeding supplies. TSA Cares can sometimes help streamline the process, though experiences vary. It also helps to bring a note from your provider explaining your medical needs and to label your bags as medical supplies.
3. Bring antiseptic wipes.
   
   They are great for quick cleanups when water isn’t available or public restrooms aren’t ideal. Always follow manufacturer guidelines for cleaning and sanitizing feeding supplies.
4. Be realistic about portable blenders.
   
   They’re great in theory, but they don’t have the power of a Vitamix® or Blendtec®. You’ll have to stick to soft, simple foods without skins, seeds or tough pieces if you use a portable blender.
5. Consider pre-ordering groceries for pickup or delivery at your destination.
   
   It saves you from having to navigate an unfamiliar grocery store right after traveling and gives you time to plan exactly what you’ll need for tube feeding meals during your stay.
6. Look up local support resources before you go.
   
   Take some time to identify the nearest emergency room and hospital at your destination. Additionally, check if there’s an Oley Ambassador near your destination. These are volunteers with firsthand experience who can answer questions and provide assistance.
7. Some resorts are incredibly accommodating.
   
   Some resorts, such as Disney, are very accommodating. Parks may have baby care stations with microwaves, and some families have even requested a Vitamix® in their hotel room. Restaurants may be able to blend meals if you reach out in advance.
8. Check out Accessible Adventures.
   
   This is a great resource for family-friendly, accessible travel tips, and destination guides (including a TON of national parks).

Traveling with a feeding tube and blended diet can feel like a lot, especially the first time. But many families find that once they do it, it’s not nearly as complicated as they expected. With a little prep and a flexible mindset, it really can be part of your normal life.

If there’s something you’ve tried that worked really well and I didn’t include it, I’d love to hear about it! You can connect with me on Instagram at @blendedtubefeeding.

Hilarie Geurink is a consultant for Nutricia North America and has been compensated to write this blog post.

By Hilarie Geurink, RD, CSP

If you’ve been thinking about trying a blenderized diet, you’re probably wondering how much work it will really take. Like, do I have to make every single meal for the foreseeable future? How will I keep up? And honestly, where do I even start?

On top of that, your medical team may have told you that formula is fine and even safer, which can leave you wondering if you’re making things harder than they need to be. And while those words might be meant to reassure you, they can make you feel stuck and unheard, especially if the current feeding plan isn’t working well for you or your loved one.

Tube feeding often feels so rigid, like there’s only one way to do it. But what if tube feeding could be more flexible, closer to how most people eat, and still meet your needs?

In this post, we’ll explore how real food can be part of your tube feeding routine in a flexible and manageable way, without the pressure to be perfect, so you can finally try it.

Making Room for Flexibility in Tube Feeding

The reality is that most people who eat by mouth do not eat the same thing every day, and they do not prepare every meal from scratch.

People eat to fuel up for a big event, because something smells good, to connect with others, or just because it’s lunchtime. Meals are often a mix of home-cooked food, takeout, convenience options, frozen meals, and snacks. Many of these choices are spontaneous and do not require strict calorie or nutrient tracking, and nobody expects that.

People using feeding tubes are no different. Some days you want to share a special meal with family during the holidays or enjoy a favorite dish made together. Other days filled with therapies and medical appointments, and you need something quick on the go.

Yet despite this, you may feel like you have to be rigid, tracking every nutrient and making every meal perfectly balanced, or you’re doing it wrong. That kind of pressure isn’t how most people eat food, and it can make tube feeding feel overwhelming and much harder than it needs to be.

It’s no surprise you feel boxed in, stuck, and unsure how to move forward. The truth is, we have made this more complicated than it has to be.

When your real life isn’t part of the plan, it’s easy to get stuck in a feeding routine that feels rigid or unsustainable. And in the process, you miss out on the benefits of real food, the same ones we encourage for everyone else.

Clinical Benefits of Real Food for Tube Feeders

I would be missing something important if I didn’t share some of the benefits of a blenderized diet and explain WHY those benefits happen. Here’s what the research tells us, and what many families notice in real life.

Studies show that people who switch from standard formula to a real food often experience fewer symptoms like nausea, vomiting, abdominal pain, diarrhea, and reflux¹. These uncomfortable symptoms can make feeding stressful and exhausting for both the person eating and their caregivers.

One reason real food might help is its texture. Blenderized real food tends to be thicker than most formulas, and this thickness may reduce reflux and vomiting². A blenderized diet also tends to provide an improved nutrient profile comprised of various whole food ingredients, mimicking the normal way food moves through the digestive system².

From my experience working with families, variety often plays a key role in how well someone tolerates their tube feeds.

Getting the same formula every day or relying on just one homemade blend, often because trying more feels overwhelming or too time-consuming, can make it harder for the body to feel good and digest well.

But the benefits are about more than just physical symptoms. Blending real food gives families the chance to prepare meals together and share the experience, helping to normalize feeding time and bring connection back to the table⁴.

Real-life success stories reflect these experiences, showing how real food can bring meaningful changes beyond just nutrition.

Why Variety Matters in Blenderized Food and Formula 

All these benefits sound promising, but I understand that you might still have questions about the practical side of things. Is blending every meal really necessary? And how do you manage it all without feeling overwhelmed?

For some, blending every meal works great. But for many, it’s about finding a balance that fits their life, and that’s where commercial blenderized formulas can be a helpful part of the plan.

They make it simpler to get started with real food, offer backup on hectic days, and help you find a feeding plan that works for you, without the stress of preparing every meal from scratch.

Here are a few real-life ways families I work with include commercial real food products in their tube feeding routines:

• Some families batch blend what they can weekly and use commercial blends to fill in the gaps
• Others use homemade blends at home but switch to commercial options when traveling or on the go. Real Food Blends® is a commercial option offering 100% real food meals with no synthetic ingredients.
• Some mainly use commercial blends but make homemade meals a few times a week for special occasions or when they have time
• Some do all homemade blends but keep commercial products for emergencies or very busy days

What’s most important to know is that you don’t have to choose one or the other.

You can create a plan that works for your family, and many families find that this flexibility helps their child tolerate feeds better and makes life feel less overwhelming.

How to Get Started with Real Food for Tube Feeding

If you’re curious about trying real food, the best approach is to start slow and simple. Try offering just one blended meal a day while keeping the rest of the feeding plan the same. This helps you or your loved one’s digestion adjust gently and keeps things manageable for the person making the meals.

Start with foods that are easy to digest, especially if your child hasn’t had much food or fiber before, or it’s been a while since you or your loved one has had real food.

Using balanced recipes with known calorie amounts can help you swap meals without worrying about missing calories or nutrients. Always check with your healthcare team when making changes to your tube feeding plan. Multivitamin and mineral supplementation may be indicated, per healthcare professional recommendation.

And remember, it’s perfectly okay if it takes time to find what works. If you keep finding yourself stuck, it’s likely your first step is too big. Starting small and keeping things realistic is the best way to find a plan that works for you.

A Balanced Approach to Real Food and Tube Feeding

Making changes like this can feel overwhelming, and it’s natural to want the best for your health or your loved one’s health. Real food often feels like a hopeful step towards that. But that hope shouldn’t come with pressure or stress.

You deserve support that meets you where you are, honoring your unique needs, your capacity, and your day-to-day life. When we let go of the idea that there’s only one “right” approach, it gives you a real chance to try. And when you do, it’s not just digestion that improves. Tube feeding often becomes more manageable, more personal, and a lot less stressful.

Hilarie Geurink is a consultant for Nutricia North America and has been compensated to write this blog post.

References:

1. Hron B, Fishman E, Lurie M, et al. Health Outcomes and Quality of Life Indices of Children Receiving Blenderized Feeds via Enteral Tube. J Pediatr. 2019 Aug;211:139-145.
2. Walker S, Johnson T, Carter H, et al. Blenderized food tube feeding in very young pediatric patients with special healthcare needs. Nutr Clin Pract. 2023;1-8.
3. Batsis ID, Davis L, Prichett L, et al. Efficacy and Tolerance of Blended Diets in Children Receiving Gastrostomy Feeds. Nutr Clin Pract. 2020 Apr;35(2):282-288.
4. Bennett K, Hjelmgren B, Piazza J. Blenderized Tube Feeding: Health Outcomes and Review of Homemade and Commercially Prepared Products. Nutr Clin Pract. 2020 June;35(3):417-431.

By Teresa Johnson, DCN, RDN, FAND

Jake began his life in the intensive care unit due to prematurity. He overcame many problems before being discharged but one issue persisted. Jake had under-developed lungs. This made breathing difficult and Jake’s calorie needs much higher than normal. He was given a high calorie infant formula in his bottle. Later, baby food was added to his diet, but Jake could not take in enough calories to grow. A nighttime tube feeding was added to supplement what he ate during the day. The nighttime tube feeding made things worse. Jake started vomiting, retching, and suffered from stomach pain when given food or formula. He stopped taking any food by mouth and even rejected his pacifier. For Jake, eating was a painful experience, and he wanted nothing to do with it. The healthcare team tried everything to resolve his feeding issues- including medications and surgery. Jake was referred to a feeding clinic to restore oral feeding skills and get his growth on track. The efforts of the team were useless until Jake’s mom made an unusual request: could Jake have real food tube feeding instead of formula?

This story reflects the growing desire for real food by many in the tube feeding population. Caregivers and patients have heard about the benefits of a whole food blenderized tube feeding (BTF). Many healthcare professionals (HCPs) endorse a healthy varied diet, and this same concept can be applied to tube-fed patients. Healthcare professionals are typically trained that only formula, water and medications should be put in a feeding tube. Parents have an opportunity to speak with healthcare professionals about BTF.

Step 1: Talk to Your Healthcare Provider/Medical Team

You’ll need to be prepared to explain why you are interested in BTF. There is strong evidence showing the benefit of BTF¹. Some who switched to BTF were able to wean completely from their tube feeding and eat by mouth. Partner with your medical team and provide them with resources and research articles like this one.

Step 2: Make sure you/the person you are caring for is a candidate for BTF

Practically anyone requiring a tube feeding is a candidate for BTF, but there are some considerations.

• Is the tube-fed person generally stable at home? In cases of acute care, a commercial formula might be needed until issues are resolved.
• Are you or the person you are caring for able to prepare safe food in a clean home environment if homemade blenderized tube feeding (hBTF) is the preferred option? Refrigeration temperature needs to be less than 41 degrees F. If BTF is stored in a freezer, the temperature needs to be zero degrees Fahrenheit. All utensils need to be clean. It’s best to cook all the ingredients to reduce risk of food-borne illness. Some foods do not blend as well as others. The Registered Dietitian-Nutritionist (RDN) can help with recipe development. It’s important to speak with your healthcare professional to determine the best option for you before proceeding.
• Do you or the person you care for require a specialized formula because of a digestion issue? Commercial peptide BTF formulas might be appropriate in this case. Check with your healthcare professional to discuss this option.
• What about the size of the feeding tube? Small bore tubes make it difficult to feed thick BTF. Although BTF may be given through any feeding tube, gastrostomy tube is preferred and at least a 12 to 14 French size is recommended.
• Do you or the person you care for require small volume feeding given over many hours? This is called continuous feeding, and it requires a feeding pump. Older pumps can’t handle the thicker BTF feeds. Although new feeding pumps are designed to deliver BTF, food safety guidelines prohibit food from being at room temperature for more than two hours. It might not be possible to deliver adequate nutrition in a two-hour time frame for a patient who can only take in small amounts. However, some commercial blenderized tube feeding products (cBTF) can be at room temperature for extended periods of time and can be delivered by pump.
• How will the BTF be given? Pump? Syringe? Gravity? New generation pumps on the market are designed specifically for BTF. A 60 mL syringe is the typical size. Feeding can take longer, and hand strength could be a challenge. A simple handle tool for enteral syringe feeding is available to help provide the force needed when feeding via bolus syringe. Gravity feeding using a feeding bag is also an option. However, the BTF must be given within the two-hour food safety window. The feeding should not be given too quickly; bolus feeding should equal the amount of time it takes to eat a plate of food- about 20 minutes. Smaller snacks in between meals take about 10 minutes to deliver.
• Another consideration is Will a provider cover the cost of the BTF? Most companies offering a commercial blenderized tube feeding product can help clients obtain coverage. Insurance companies do not cover the cost of homemade blenderized tube feeding. Nutricia Navigator is a helpful product coverage and access assistance program, which you may contact for free personalized one-on-one support.
• Those wanting homemade blenderized tube feeding need to account for the time commitment of cooking multiple meals per day. An expensive, high-capacity blender (1100 watts or greater) will be needed. The pitcher should be large enough to accommodate a liter of BTF (34 ounces or more). Most retail blenders cannot handle the volume of blending that homemade blenderized tube feeding requires. Baby food recipes are available for those who want to experiment with BTF before purchasing a commercial grade blender. Another option is to utilize one of the many available commercially prepared BTF products, such as Real Food Blends®. These are convenient alternatives to preparing BTF at home. Real Food Blends is 100% real food with no synthetic ingredients, offers variety with 8 different meals and a snack, and most closely mimics homemade blenderized tube feeding compared to other blenderized enteral formulas.
• Some make batch feedings and freeze homemade blenderized tube feeding for the week. This requires a lot of food storage space and must be taken into account. Others use a combination of commercial blenderized tube feeding and homemade blenderized tube feeding. Containers will need to be labeled and dated when stored in the refrigerator or freezer. Discard any unused homemade blenderized tube feeding in the refrigerator after 24 hours.
• Make a plan for situations where homemade blenderized tube feeding is not practical (e.g., travel, hospital admissions, school, etc.).

Step 3: Start Transition

After determining the type of BTF preferred and getting the needed materials to support BTF, transition begins. If homemade blenderized tube feeding is used, start with simple recipes and watch for any adverse reaction to a food. Ideally, one bolus commercial formula feeding will be replaced with BTF over several days. Some on a continuous tube feeding replace half of the commercial formula with a commercial blenderized tube feeding over several days. If no problems are observed, full transition can proceed over a one-week period. Your healthcare professional can also help identify a commercial blenderized tube feeding if desired. Many use commercial blended products exclusively or in combination with homemade blenderized tube feeding. The RDN can help with trouble shooting. Work closely with the RDN to make sure the prescribed BTF volume is given, and the patient meets nutritional needs and receives the proper amount of extra water.

Step 4: Monitor

Everyone on a tube feeding needs to have follow up with an RDN. This is especially true for the BTF-fed individual. The nutrition profile of the BTF needs to be compared to the nutrition needs of the individual and adjustments made if/when issues arise. Homemade BTF recipes need to be analyzed. Homemade recipe adjustment or supplements might be needed. Lab work, weight and growth patterns will need frequent monitoring. Drug/nutrient interactions should be considered.

Back to Jake

The feeding team mixed baby food green beans in Jake’s tube feeding formula while in the clinic and gave him a bolus feeding. They waited for the usual response- retching, vomiting, stomach pain- but it didn’t happen! Although the RDN and Jake’s mom had no experience with BTF, they worked together to find resources and transition him to home blended real food feeding. He began to take food by mouth again and was eventually weaned completely from the tube feeding.

Everyone’s story will be a little different. Jake’s mom was concerned for her son’s health as he could not tolerate more than ½ an ounce of formula in an hour! Others switch to BTF because they want feeding to feel less like another medical treatment. Many have different journeys to blended tube feeding, but state it’s the best decision they have ever made.

Dr. Teresa Johnson is a consultant for Nutricia North America and has been compensated to write this blog post.