Things to consider before getting started

Make a plan - everybody’s transition to the blended diet is different. It’s important to make a plan with the healthcare professionals involved specific to your needs.

Volume tolerance

People that have been eating solid food orally, can often simply switch over to blended diet using foods that were previously tolerated. However, for those who have never eaten solids, volume tolerance can be an issue. It is best starting with small amounts of 5-10ml, before building this up slowly. Over time volume tolerance often increases.

Introducing new foods

If introducing foods for the first time it is best to introduce them one at a time so you can spot any reaction, especially for foods that can trigger allergic reactions, like nuts. You may find some foods are not tolerated as well as others. To help identify these, and to monitor progress, it is a good idea to keep a record of symptoms like bloating to help inform what you blend in the future.

Blending method

The approach to blending itself also varies, some people prefer to batch blend and freeze meals, whilst others prefer blending each meal at a time, or a combination of the two. Whatever approach you use it is important before you start to consider the time and work involved, as well as the equipment needed.

Equipment

  • Blended diet is most commonly given through a Gastrostomy, via a Percutaneous Endoscopic Gastrostomy (PEG) or PEG Button. It can also be given through a Nasogastric tube. We would not recommend using the blended diet for a Jejunostomy (J tube) without specialist support.

    It is important to consider which feeding tube you have when using blended diet. Narrower tubes may require the food to be thinned with more liquid, which will change the nutrition and volume provided. With a button an extension set is needed. If you have a right angled connection, you may find that this creates more resistance. 

    Many people worry about their tube becoming blocked with the blended diet. We have not seen any evidence of more blockages with the blended diet. If you are concerned you might want to wait until the stoma is established and the PEG, which requires surgical replacement, is changed to a button, which doesn’t.

  • Blended diet is usually given as a bolus using a 60ml syringe. The best syringes for blended diet are of an ‘O-ring’ design and not those with a rubber end on the plunger, which can detach when drawing up blended food.

  • There are various blenders available, it is always a hot topic with people on blended diet! Most can be used for blended diet, but the type of blender being used dictates what you can blend effectively, and how much in one go.

    • Commercial blenders can blend almost anything and have the power to batch blend meals, these are usually expensive.

    • Mid-range blenders can usually cope with most things including nuts and seeds. You may need to blend smaller volumes or blend for longer than with commercial blenders.

    • Stick or low power blenders can’t cope with some harder or fibrous food so best to be used with softer-cooked foods.

    Although not always necessary to sieve the blends before use it can give an extra piece of mind, especially if using a lower powered blender.

  • Particularly when batch blending you need to make sure that you have food safe containers and freezer space to store the food. You will also want labels to date when it was made and name the meals, so you know what you have made! 

    You will also want to have cool bags and ice blocks to transport the food safely when away from home. This can be a challenge when away for longer periods like holidays or when going to schools, hospitals or respite. This is where Wilbo’s Blends can really help.

Tips for transitioning

1.

We think it's a good idea to work towards eating at usual mealtimes (breakfast, lunch, dinner; or is that dinner, tea…) with some snacks in between. It’s not always possible, some people need continuous or overnight feeds, but it's a good thing to aim for to help make managing meals much easier.

2.

Don’t forget to drink. Free water is really important, and the amount of water needed can be different from formula feeds. Food slows gastric emptying, so we recommend giving water half an hour to an hour before the feed. This should give it time to be absorbed and not impact volume tolerance with the food. As with everybody, passing light coloured urine regularly is a good indication of being well hydrated.

3.

If you are used to pump feeding, bolus feeding can seem a little daunting. When administering in this way, you will get a feel for how much pressure is needed, and the speed at which to push the food through – as this will differ for each person. A good rule of thumb is to give the feed at a similar pace to which anybody else would eat a meal. Of course, some people eat quicker than others and some people can’t tolerate too much at once.

4.

Bolus feeding is convenient and easy for most people and can give a satisfying feeling of being full, unlike with liquid feeds. Sometimes bolus feeding isn’t right or possible so we recommend watering down one of Wilbo’s Blends with water, juice, milk or formula so that it can be used with the pump.

5.

Finally, we recommend keeping a record of the foods being given, weight gain and loss, and any symptom changes. This is especially useful when introducing new foods that may not be tolerated as well. Remember that food is absorbed differently to formula, and you may need more or less calories than was needed with formula.

How to give Wilbo’s Blends or home blended diet

1.

Prepare the meal so that it’s at a comfortable temperature to eat and not too thick (you might find when the food cools it thickens up).

2.

Fill the syringe. Some people prefer to draw up the food into the syringe, or cut the end off an extension set to help do this. Other people prefer to pour in from the top and replace the plunger. Once full remove any excess air by tapping the syringe (trying not to squirt food onto the ceiling as you do this).

3.

Attach to the gastrostomy and ensure if using an extension set that it’s primed.

4.

Apply gentle pressure to the syringe. The speed you give the meal varies from person to person but thinking about how fast you would normally eat orally gives a good idea of speed.

5.

When all the food has been given from the syringe, or the meal is finished, give a water flush.