Tuesday, February 25, 2014

Blended Diet

Last week on on Facebook, I think I confused a few people when I excitedly announced the arrival of our new Blendtec blender. I said that we would be using the blender to feed our tubie baby, and some commenters thought that I was blending food to feed Elsie orally. Well, as much as I wish that were the case, it just ain't happening right now. Elsie is still extremely limited on what she eats by mouth. She doesn't actually "eat" anything orally, she just tastes things and then spits them out. We did have a very exciting moment a few weeks ago when Elsie ate an entire Gerber cereal puff. It was pretty awesome, and I cried, but she hasn't eaten any since. She just sucks on them and spits them out. Same scenario with yogurt melts; she ate a piece of one once but hasn't repeated the amazing feat yet. Just sucks on them. She tastes lots of foods, which is very encouraging, and she's heading in the right direction for eating orally someday, but it's still going to take a long time. So anyway, we're not using the blender for oral foods. We are blending food to feed her through her tube.

There is a relatively new trend in the tube-feeding world, and it's called the Blended Diet, or Blenderized Diet. Let's call it "BD" on this post so that I can be lazy with my typing. The basis of the BD is that formula (what the majority of tube-fed babies/children/and even adults are typically fed), while great in certain situations, is not the best thing for your body to be fed for a prolonged period of time. The human body is designed to digest food: fruits, veggies, meat, grains, dairy. A slice of pizza. In many many instances, tubies who had a hard time with formula (chronic vomitting, constipation, retching, poor weight gain, and other digestive problems) have been able to improve their overall health when switching to a BD. I've said it before, but I'll say it again: if I wanted my kid to be on a formula-only diet, I would have saved myself a lot of trouble and stopped pumping breast milk a looooong time ago. Hence, when I heard about the BD, I knew that it was what I wanted to do for Elsie's tube feeds when we transition off of breast milk. So what exactly is BD?

BD is simply that, a blended diet. It is natural food blended into a thin enough consistency to be able to go through a feeding tube. One of the greatest things about BD is that you can individualize exactly what goes into your BD. Need to go gluten-free? No prob. Just don't add gluten to your blends. Need more calories? Add more calorie dense food to your blends. Dairy-free? Nut-free? Doritos-free? Easy. You can put virtually anything in your BD--or omit anything you don't want--and make it specific to your exact needs. Another benefit of the BD is that tubies are sometimes more likely to start eating orally when they are fed real, blended foods. The reason is that the tubies can "taste" the real food when they burp, they get familiar with the tastes, and are more likely to try foods orally because they recognize the taste. Not so much with formula. Have you ever tasted a formula burp? Gross.

There are a few different approaches to BD. Some people are very conscientious about calorie-counting; putting in very specific amounts of carbs, fats, and protein, in a specific amount of calories, to meet the tubie's dietary needs. Some people are all-organic, all-natural, wholesome foods only, etc etc etc. Some people, whose dietary needs are less strict, resort to simply blending whatever the rest of the family is eating. If the non-tubie family members are eating scrambled eggs and pancakes, that's what goes into the blender for the tubie. There's a blog that I've been reading about an adult with a feeding tube who, when his family goes to a restaurant, brings his Blendtec blender to the restaurant, orders off the menu, and has the kitchen staff blend his order so that he can "eat" it. BD is extremely versatile. As long as you are using a blender that can sufficiently blend the food and remove ALL chunks, you can blend just about anything.

We are just starting out on our BD journey. Elsie's doctors have recommended that she receive breast milk or formula as her main source of nutrition until her adjusted age is 12 months; same as any other baby. Since she will be 12 months adjusted in May, we are starting to introduce new foods so that her tummy can get used to other food besides milk. We've started out slowly, introducing one new food at a time, just like any other baby, to make sure that she doesn't have any adverse reactions. So far we have blended and tube-fed pears, peaches, sweet potatoes, applesauce, pinto beans, and brown rice with chicken broth. We mix her food with breast milk and either coconut oil or vegetable oil, for added calories and fat. And she's doing great so far! No digestive problems at all.

One of the few negative aspects of BD is the possibility of clogging the tube. As long as you have a high-powered blender OR you are sufficiently removing chunks via a fine strainer, clogs in the tube are easily avoided. However, I must admit, I clogged Elsie's tube for the very first time today. Ha ha. But really, it was my own fault because I was being lazy. I had previously cooked and blended brown rice with chicken broth, as I mentioned before, and had some in a container in the fridge that I was mixing in with Elsie's pears this afternoon. Since the rice had been in the fridge for a day or two, it had solidified, but could be easily stirred into the pears with a spoon. Or so I thought. Unfortunately, my spoon missed a chunk, and the chunk got stuck in her tube. Luckily, after making a big mess and trying for 15-20 minutes, I was able to push the clog through with some warm water. What I *should have* done, was throw the pears and rice into the blender before serving it, even though it was previously blended. The Blendtec would have smoothed out any offending chunks and prevented the clog. Lesson learned.

Anyway, that's the basics of the BD. Any questions? I'm so happy that I have a wholesome way of feeding my little tubie. Someday, someday she'll be able to eat by mouth and enjoy the taste of food. Someday she will find eating a pleasant experience. Until then, I'll be in my kitchen with my blender.

Tuesday, February 4, 2014

13 months!

Little miss Elsie is 13 months old today--Wow!!

We had a busy day today; it was Elsie's second appointment at the Neonatal Follow-up Clinic. This is a clinic where preemies are seen by several different providers a few times a year for the first few years of their life to make sure that they have the resources and referrals that they need to grow and succeed. That was a long sentence. You can read about Elsie's first visit to the NF Clinic here.

Today's visit was pretty great. We saw an audiologist, a nutritionist, a nurse-practitioner, and a physical therapist. All of them were thrilled with Elsie's progress and said that she's doing fantastic, of course, because she is.

She passed the hearing test with flying colors. The nutritionist said she's very pleased with Elsie's weight gain; she is at about the 50th percentile for height and the 30th percentile for weight and is consistent with staying on her curve (both height and weight here are for her adjusted age, not her actual age). She gave me some tips and resources on transitioning someday from Elsie's current breast milk-only diet to a blended food diet, which is more desirable than a formula/pediasure-only diet. Because let's be honest, if I wanted my baby to be exclusively fed formula, I would have stopped pumping a loooong time ago. Not that formula is evil. It's not.

The physical therapist's evaluation was great--remember how I said that I was excited to show her that Elsie could crawl and move out of the sitting position and prove her wrong--she was so thrilled to see Elsie mobile. Her low muscle tone is gone. She is meeting all of the milestones for a 9-month old baby (which is her adjusted age) with her motor skills. Her cognition, language perception, and expressed language are all within the normal limits of a 9-month old. A few things are above the 9-month range, and one or two things are below, so all in all, she is a typical 9-month old baby. Just not typical, because you know, she's a super special 13-month old in a 9-month old's body.

While we were at the clinic, I talked to another parent who was there with his 4 year old daughter. She was a 25-weeker and stayed in the NICU for seven months. She had a gtube, but has successfully been weaned from it and has had it removed for almost a year now. The dad told me to be patient and that it would happen for us. It was nice to talk to him and I'm happy that they no longer need the feeding tube, but the thing that stuck in my mind was that their kid was a 25-weeker and had a seven month NICU stay. Elsie was a 23-weeker. Five month NICU stay. Elsie is a pretty dang healthy baby. This little girl was . . . not as healthy. How did we get to be so lucky? How is it that Elsie is doing so well, when by all the odds, she should not have even survived? Why do some have physical or mental conditions and some do not? We'll never know the why's, but we are certainly always thankful for the miracles that we have had. We're thankful everyday for our little Elsie.

All bundled up! We went for a stroll a few days ago. I get tired of being in the
 house all day every day. It was chilly (40-ish degrees) but we had fun, as you
can see by the expression on her face, ha ha.

Glasses on, check. Hair combed over, check. Stogie--I mean, Tootsie Roll--in mouth, check.
Cutest old man--I mean, baby girl--ever!

And here we are, chilling on the floor of the clinic today. Good times
were had by all!