Ask a Dietitian: Q&A
Each month, we ask a dietitian your burning questions to help give you the tools to manage tube feeding confidently. Have a new question for us? Email email@example.com
Contributing expert: Annina Whipp, Specialist Paediatric Dietitian
Ask a Dietitian: Q&A with Annina Whipp
Q1. How do I know if my child is getting all the nutrients they need from a feed? Should I be giving them multivitamins?
Whether or not a child should be given multivitamins is dependent on their nutritional requirements and whether they are exclusively tube fed or if they are able to eat.
Formula tube feeds are nutritionally complete in specific volumes, according to the age of the child. This means that they meet all the requirements for energy, protein, fat, vitamins and minerals, and therefore there is no need for additional supplements.
Some children have high energy requirements and will either need a larger volume of feed or a high energy formula. Other children have low energy requirements or are fluid restricted and are given a smaller volume of feed. As a result, they may not meet all of their micronutrient requirements. A dietitian may recommend a suitable multivitamin that can be given via a feeding tube for added support.
Children who have a blended diet are closely monitored by their healthcare team. Sometimes, nutritional deficiencies may be identified and a vitamin or mineral supplement will be needed to correct this.
As each child is different, you should discuss a child’s needs with their dietitian before buying any over-the-counter supplements.
Q2. How do I know if my child is tolerating their feed / a new feed?
When changing feeds, your dietitian will provide a feeding plan. This helps children transition to the new feed gradually to help with tolerance. It is helpful to keep a feed and symptom diary when transitioning between feeds, to help monitor any changes or concerns.
There are several signs you can look out for to see if a child is not tolerating a feed. Speak to your healthcare professional or dietitian if you notice any of the following symptoms appear:
- Loose poo that does not settle after 1-2 days
- Fewer poos than normal
- Constipation (fewer than two poos a week, poos that are hard, dry or lumpy, or poos that are difficult or painful to pass)
- Increase in reflux
- Bloating or stomach pain or discomfort
Q3. How do I make sure my child is getting enough energy / calories from blended meals?
It can sometimes be challenging for a child to meet their energy requirements when following a blended diet, as it is delivered in small volumes (boluses) of approximately 60-200mL (depending on the age, weight and tolerance of the child). Food fortification refers to adding foods high in calories or other nutrients – your dietitian may therefore recommend fortifying the child’s blended meals.
Remember, it’s important to check that the child can tolerate any food before including them in a blend. Consult your dietitian for advice on whether you should avoid certain foods / ingredients.
Example of energy-dense foods include cheese, full fat milk, cream, condensed milk, olive oil, avocado, nut butters and custard.
Q4. Do you have any ideas of how I can increase the energy / calorie content of a blended meal?
Here are some examples of sweet and savoury boosters:
- 1½ tablespoons of double cream
- 2 tablespoons of condensed milk
- 1 small handful of grated cheese
- 1 tablespoon of mayonnaise
- 1 tablespoon of smooth peanut butter
- 1 tablespoon of olive oil
- 2 cubes of butter
- 2 tablespoons of hummus*
- 2 tablespoons of pesto
- 2 tablespoons of salad cream
- 2 tablespoons of hummus*
*Certain foods like hummus, pesto and peanut butter may change the consistency of the blended food, so you may need to add more liquid.
Check back for further recipe ideas soon.
Q5. How should I keep an eye on my child’s weight (including tracking weight loss / weight gain)?
The red book given by the child’s midwife when they were born contains growth charts to help track the child’s height and weight. They’re made up of lines called centiles or percentiles and numbers. The lines show the expected pattern of growth, while the numbers refer to the percentage of children at or lower than the line. For example, if a child’s weight is on the 50th centile, this means that 50% of children of the same age are either at the same weight or less.
There are separate charts for girls (up to 20 years old) and boys (up to 18 years old), as well as separate charts for children with certain conditions including Trisomy 21 or Cerebral Palsy, as specific conditions can affect growth patterns. Try not to compare height and weight changes with other children – it’s more important that their height and weight is moving along the same curve (which is sometimes referred to as ‘tracking’).
If a child’s weight has either dropped or increased by 2 percentiles or more, you should speak to your dietitian or healthcare professional.