By: Amanda Gordon, RD, LDN, IBCLC and Dan Frazier, RDN-AP, CNSC
Parents feel fulfilled when they feed their children healthy
foods. Foods that are fresh, colorful
and taste good. Foods sourced from quality
ingredients. Food that are less
processed and contain fiber and other nutrients that make our bodies work
well. Foods that provide energy.
There is an important movement afloat in the nutrition world
and a growing body of scientific evidence that supports the idea that children
with feeding tubes should eat real food too.
Tasty, nutrient-dense, colorful food.
The same food that their parents eat.
The same food that other children eat.
February 10-14 is Feeding Tube Awareness Week, a campaign initiated
by the Feeding Tube Awareness Foundation to bring awareness about tube feeding (https://www.feedingtubeawareness.org/). So, what better time than now to talk and
think about children with feeding tubes.
Many adults and children alike are reliant on tube feedings
at home to deliver adequate nutrition and hydration. Studies using Medicare and Medicaid data in
the United States indicate that the use of home tube feeding is on the rise in
the United States.1 According to data from the Feeding Tube
Awareness Foundation, children 18 and under represent about 40% of the tube fed
population.1 There are many reasons why a child may have a
tube placed for feeding and hydration. These
can include medical diagnoses, including prematurity, physical, anatomical, or
Feeding tubes can also be placed for children with swallowing
difficulties and in situations of pediatric feeding disorders (which are also
on the rise in the US).2 And, for
those who may question or doubt the reality of a pediatric feeding disorder
being a real thing, just ask any family who has had a feeding tube placed in
their child for this reason.
Feeding children through a feeding tube can be very
stressful for families. It can take the
whole concept of eating and turn it into something medical. Eating is supposed to be social and enjoyable. When nutrition has to be delivered through a
tube, this can change the dynamics, meal times, and how a family views
nutrition for their child. And for good
reason. Up until a few years ago, most children in the US were fed primarily
medical formulas and nutrition supplements through a feeding pump that
delivered nutrients on a set regimen over a 24 hour period. (No wonder this would feel more medical that
However, families today have more options for feeding children with tubes who are over 12 months old. There is a strong movement, backed by growing scientific research, to feed real food to children with feeding tubes. Yep. Chicken, fish, eggs, fruits, vegetables, milk, yogurt and other dairy. All kinds of stuff.
While some children have medical conditions that require
specialized formulas to deliver specific nutrients through a feeding tube, many
families are moving away from conventional formulas as possible. With the help of Registered Dietitians who
specialize in this area, children with feeding tubes now have the opportunity
to eat the same foods that their families, caregivers, and friends eat. Parents blending foods in their kitchens are
able to feed this to their children.
Recipe sharing and books are now published on feeding table foods to
children with feeding tubes. There are
also a growing number of companies that are creating wholesome meals meant for
children with feeding tubes.
Feeding children real foods, table foods or family foods can
help children feel better. Studies
indicate that children who eat food by tube instead of formula often have
improved tube feeding tolerance due to an improvement in gastrointestinal
symptoms such as nausea, vomiting, diarrhea, and gagging/retching3,4,5. Additionally, for kiddos able to eat orally,
studies indicate that those using real food versus formula have decreased oral
aversion and increased oral intake4.
Parents and caregivers often feel better as well. They feel more empowered by the ability to nourish
their children well. Many families
relish the opportunity to feed their children family and culturally-appropriate
foods. Most importantly, they often feel
less stress overall as the feeding experience normalizes in a sense and doesn’t
alienate their child. Not surprisingly,
parents using blenderized tube feeding reported feeling that their child was
happier and healthier; they also unanimously recommended blenderized tube
feeding to other parents6.
In many ways, the discussion around feeding real food feels
full circle. Prior to the inception of
formula in the 1960s, people with feeding tubes were given real food. It is exciting to see this become popular
again and given the clinical studies substantiating this practice, in
conjunction with the overwhelmingly positive response from parents, feeding
real food to children with feeding tubes will likely become more common.
The USDA Dietary Guidelines recommend eating a variety of
nutrient dense foods for all Americans. Children
with feeding tubes should not be excluded from the opportunity to enjoy real
food. It is our hope that families and Registered Dietitians continue to
advocate for the concept of feeding as eating, not a medical procedure.
Amanda Gordon, RD, LDN, IBCLC is a pediatric dietitian at Feed to Succeed, LLC, a private pediatric nutrition practice. Feed to Succeed works with families on food-based tube feeding diets for children and on weaning children from tube feedings. For more information, visit http://www.feedtosucceed.com
Dan Frazier, RDN-AP, CNSC is a Registered Dietitian with Real Food Blends. Real Food Blends makes 100% real food meals for individuals with feeding tubes. To learn more, visit http://www.realfoodblends.com
1. Mundi MS, Pattinson A, McMahon MT,
Davidson J, Hurt RT. Prevalence of Home Parenteral and Enteral Nutrition in the
United States. Nutr Clin Pract. 2017;32(6):799-805.
D, Grover Z. Tube feeding: Stopping more difficult than starting. J Paediatr
Child Health. 2015;51(3):245-247. doi:10.1111/jpc.12763
B., Fishman, E., Lurie, M., Clarke, T., Chin, Z., Hester, L., Burch, E. and
Rosen, R. (2019). Health Outcomes and Quality of Life Indices of Children
Receiving Blenderized Feeds via Enteral Tube. The Journal of Pediatrics,
4. Pentiuk, S.,
O’Flaherty, T., Santoro, K., Willging, P. and Kaul, A. (2011). Pureed by
Gastrostomy Tube Diet Improves Gagging and Retching in Children With
Fundoplication. Journal of Parenteral and Enteral Nutrition, 35(3),
5. Batsis, I., Davis, L.,
Prichett, L., Wu, L., Shores, D., Au Yeung, K. and Oliva- Hemker, M. (2019).
Efficacy and Tolerance of Blended Diets in Children Receiving Gastrostomy
Feeds. Nutrition in Clinical Practice.
6. Gallagher, K., Flint,
A., Mouzaki, M., Carpenter, A., Haliburton, B., Bannister, L., Norgrove, H.,
Hoffman, L., Mack, D., Stintzi, A. and Marcon, M. (2018). Blenderized Enteral
Nutrition Diet Study: Feasibility, Clinical, and Microbiome Outcomes of
Providing Blenderized Feeds Through a Gastric Tube in a Medically Complex
Pediatric Population. Journal of Parenteral and Enteral Nutrition,