We started an 18-month-old female with distal arthrogryposis, congenital hypotonia and myopathy, and respiratory involvement on a combination of home blended tube feeds, breast milk, and Real Food Blends after significant formula intolerance. As a baby, she vomited every formula, including amino acid based formulas. She had frequent watery stools and was sick often. Her GI specialist recommended a 24 hour continuous drip to improve her tolerance. When she switched to a blenderized diet, she was able to tolerate more formula without vomiting. Her weight gain improved significantly, and she began making developmental strides that her neurologist never predicted she would make, such as talking, rolling, and sitting. Today, at 4 years old, she is taking nearly 100% Real Food Blends through her Gtube and is even working on taste trials using Real Food Blends. She is energetic, talking up a storm, and a light in our clinic. She is working on supported standing and walking with her PT, and her weight and length have been within normal limits for more than 2 years.