The do’s and don’ts of pre-weaning can be difficult to assess and navigate. In particular, many families wonder about their child’s tolerance of tube feeds and how they might adjust in order to make the experience more comfortable and conducive to oral intake. Blended diets, in particular, spark curiosity, so let’s take a look at how they might factor into your child’s pre-weaning stage.
It’s true that a blended diet can be helpful in sparking interest in oral eating for a few reasons. If there is an intolerance or discomfort with formula, a blended diet can be tailored to be more easily digestible. It’s food – and our bodies were made to process real foods, and increased gastric comfort leads to food seeming like a better idea. Along the same lines, real food can be digested more quickly, allowing for feelings of appetite to emerge slightly between meals. And, as funny as it might sound, one theory says that we taste our burps. So, if a child is eating tasty food via her tube, she might get some "tastes" which can again inspire some interest in eating. This is especially true for children who have vomited formula for a long time and for whom the formula taste/burps are associated with discomfort.
However, just as you would not shift an orally eating child's diet 180 degrees in one go, switching to blends should follow the same pattern as with an orally eating child. Think of the tube as another food delivery mechanism, but not the determinant of food: for babies, start with simple baby foods added to the formula/EBM base like fruits, veggies, cereal, and yogurt. Then move to more complex foods.
But as far as transitioning to a blended diet before weaning begins, we’d say that it depends on how tube feeds are currently being tolerated. If they are not, and blends are a trial to see if a child can tolerate enteral feeds better, then it can make sense to make this transition before weaning. That said, weaning brings oral eating. As we discussed here, we do not expect fully tube fed children to take substantial oral volume (if any volume at all) prior to weaning from the tube. So if you don't want to change too many things at once, keep tube feeds as they are (if they are tolerated) and wean to oral foods and formula.
Elisabeth Kraus, MiT, Parent and Family Coordinator