Nourishing the Most Vulnerable Children

I'm thrilled to share that our daughter Laura just completed her Master’s degree in Public Health at the University of North Carolina. She will soon be a practicing Registered Dietitian with a focus on healing using an ancestral/traditional diet. To recognize her accomplishments, I want to postpone the third in my series on nutrition education for preschoolers to share what I learned from her Master’s research. Laura explored the use of whole foods for tube feeding children. While this may sound relatively unexciting to most of you, for those who have a child dependent on liquid formulas fed through enteral tubes, this could be life changing information.

As way of background, Laura and I both did pediatric rotations in major university hospitals as part of our training. It is relatively common in these settings to see children who have most (if not all) of their nutritional needs met by what are called enteral formulas, very much like the popular nutritional drink called Ensure, but tailored to a child’s age and nutritional requirements—at least that is the intent. There are many reasons a child may be placed on a tube feed, too numerous to mention here, and some babies actually go straight from baby formula to this type of feeding.

While some children seem to do well on these formulas, which contain things like maltodextrin, sugar (yes, sugar is often the second ingredient), milk protein concentrate (mostly casein which when heated to high temperatures and can be hard to digest), soybean oil, canola oil, and artificial flavors, other children suffer from negative side effects such as painful reflux, wretching, constipation, diarrhea, weight loss, or even failure to thrive. I often thought when I was in my pediatric rotation how distressing it must be for the parents of a child who was prescribed a tube feeding who have no option but to give them one of these commercially produced formulas. I could not imagine myself having to consume one of these as my sole source of sustenance, much less my own child! Most parents, however, are not offered an option to use whole foods as a base for their child’s tube feeding, which I feel is a shame.

I should be clear that Laura stressed that as dietitians, we can only recommend a change from a commercial formula to a blenderized whole food one when the parents or caretakers initiate the interest in doing so. In the major pediatric care centers, I would suppose that rule must be adhered to. However, for myself and others in independent private practice, parents might welcome the suggestion as many might not even be aware that it is a viable option.

Laura developed several recipes using whole foods, such as chicken, milk, beef, cooked grains, vegetables, fruits, and essential fats, as well as recipes containing commercially available stage 2 baby foods. The whole foods recipes require a good quality blender, while the baby foods can simply be whisked together with a liquid such as milk. What I like about the whole food recipes is that parents are now able to share with their tube fed child the very same nourishing foods they are feeding the rest of the family.

I learned from Laura and her internship director that children often do much better on these homemade formulas, and the risks of moving from a commercial formula to real food are minimal as long as certain basic precautions and preparation methods are adhered to. Generally, however, a knowledgeable and open-minded dietitian should be consulted to assess the nutrient content of the homemade formula and determine whether it is meeting a child’s needs over time.

You can find out more about this feeding approach from Laura’s narrated slide show.

If you know a family who has a child that needs tube feeding (outside of the hospital), I would strongly encourage you to share this information with them. Thank you!