Tube and PEG feeding real foods

How to introduce wholefood nutrition to tube-fed children

Hearing that your child needs a feeding tube is a daunting experience for any parent.

Immediately the mind is filled with questions. What do I feed them, how do I do it, what happens if something goes wrong?

The loss of the enjoyment of eating and tasting the foods they love is distressing for children too, especially those with siblings who can continue to eat normally. 

As both a naturopath and a mother of a tube-fed child, I have had both professional and personal experience with this journey.

My experience with tube feeding real foods

Despite years of caring for children with complex health issues, it was difficult news to hear when doctors told us our daughter needed a PEG feeding tube, after seizures took away her ability to chew and swallow safely.

Despite this setback, I set about finding natural real-food alternatives to the standard tube-feeding formulas. 

Within just six months she had gained three kilograms, after two years of no weight gains. It

also supported a return to healthy daily bowel movements, and stopped her reflux, all without medications. 

This experience cemented my inner knowing that wholefood nutrition is just as important – if not more so – for tube fed children. And now I’m determined to support other tube-feeding families in making the transition to real food.

What is tube feeding?

There are several different types of tube feeding, including:

  • Orogastric Tube (OGT) – Thin soft tube passed through a child’s mouth, through the oropharynx, through the oesophagus and into the stomach 
  • Nasogastric Tube (NGT) – Thin soft tube passed through a child’s nose, down the back of the throat, through the oesophagus and into the stomach. 
  • Gastrostomy tube – a feeding tube which is inserted endoscopically or surgically through the abdominal wall and directly into the stomach. 
  • Temporary balloon device (G-Tube) – a gastrostomy tube  
  • Percutaneous endoscopic gastrostomy tube (PEG) – a gastrostomy tube which is held in place with an internal fixator 
  • Gastrostomy-Button (Mickey-Button™) – skin level button gastrostomy tube inserted into a pre-formed stoma. 
  • Gastric Residual Volume (GRV’s) – the amount of fluid aspirated from the stomach via an enteral tube to monitor gastric emptying, tolerance to enteral feeding and abdominal decompression. Once removed it may be returned to the patient or discarded.  
  • Trans-Anastomotic Tube (TAT tube) – Utilised after surgery to repair oesophageal atresia inserted by surgeons in the Neonatal patient population. 

Source: Royal Children’s Hospital  

These tubes may be needed permanently or short term, and for a variety of reasons, including disability, injury and trauma, physical or mental illness, and after some surgeries.

Tubes may enter through the mouth, the nose, or directly into the stomach and parents and carers need to learn how to safely maintain and clean the tube to prevent infection. 

Ready-made nutritional powders and formulas are commonly recommended for tube feeding, but these products don’t offer the same variety and benefits of real foods.

These formulas usually contain starch from various sources, sugars (including high fructose corn syrup), protein, lipids or fats, and other, often synthetic, nutrients. 

What I’ve found is that most of these products lack antioxidants, phytonutrients, fibre and other micronutrients that are found in real foods. They also contain preservatives and other artificial ingredients that may be potentially harmful for childhood health and development. 

Benefits of real food for tube feeding

There is growing interest in using real foods in the form of a blenderised diet for tube-fed children. Using wholefoods blended to a liquid consistency safe for tube-feeding requirements provides the same multifaceted benefits of any wholefood diet, including:   

How do you safely feed real food through a feeding tube?

Before making any changes to a tube-feeding diet, it’s important to consult with your child’s care providers, and a practitioner experienced in tube-feeding real foods.

  • A gradual introduction of real foods can help the gut adjust to more nutrient-dense foods. And including a mix of foods, not just fruits and vegetables, is needed to ensure your child is getting adequate nutrition for their individual needs – including a mix of protein, fat, carbohydrates, vitamins and minerals. 
  • Foods should be well cooked, pureed or blended in a high speed blender and also strained to remove any solid matter that may clog the tube. Usually only some juices may be given in a raw state. 
  • Do not give hot foods through a tube or reheat foods in a microwave or on the stove-top without checking that the temperature is tepid. 
  • Take great care to adopt stringent hygiene practices when cooking, blending, and administering wholefoods. Thoroughly wash and sanitise hands and appliances.

What about ready to use blends made from real foods?

If you would like to give your child the benefits of real foods without having to make your own at each meal, there is a growing number of natural tube-feeding pouches.

These include offerings from producers such as:

These offer the convenience of real wholefoods in a ready to use pouch, without preservatives, additives and other harmful ingredients. 

This article is not intended as medical advice. If you have been giving commercial preparations to your child for tube feeding, do consult your child’s health practitioner before changing your child’s diet. Your child may have specific dietary needs like a ketogenic diet which requires close monitoring. Make any  changes gradually to enable the child’s digestive system to adjust. 

If you’d like naturopathic support caring for a child with tube feeding or a PEG, book an appointment with me.