What do you feed a tube fed child?

We made a big push to get Gabriel off formula as soon as possible, and at one year adjusted age, we were given the green light. It was a great decision for him as it has increased his willingness to work on spoon-feeding and investigate foods, and it has made his reflux almost completely disappear. Most kids, you feed them what they'll eat, and they tell you when they're hungry and you do your best to make sure it's all nutritionally balanced. With Gabriel, he can't tell us he's hungry or when he's full, so he eats on a fairly strict schedule and we have a set number of calories prescribed by the dietician that we need to try to get into him every day. It can be an overwhelming task -- how much of each type of food do you need to give them? Do you need to track each type of calorie or is overall calories good enough? Is fat bad? Is sugar bad? What foods are allowed? Some kids need a specific diet to manage certain disorders, but Gabriel is okay for just a regular diet.

I started with the Choose Your Plate guidelines through the USDA. It's the new food pyramid. On their website, they have several diet plans that you can choose from based on age and calorie requirements. I use the 1000 calorie, 2-year-old plan which calls for 3 oz. of grains, 1 cup veggies, 1 cup fruits, 2 oz. meat/protein, 2 cups dairy, and 1 Tbsp oils. It also tells you sugar and sodium limits per day, but honestly, I don't track that. When they made this plan, they tell you to use 2% milk and limit fats -- according to the dietician, full fat anything is recommended for up to two years, so we look for foods that give us the highest calories per volume. At full recipe (including the nighttime feed), this yields 1313 calories per day. I try to give a variety of things and came up with this diet plan (this is the most recent incarnation, it's gone through many changes based on Gabriel's needs and tolerances):

Breakfast:
1/8 c. steel cut oats (cooked)
1/8 c. multigrain baby cereal
1/2 container (1.25 oz.) baby food prunes (for constipation management)
1/8 c. papaya (enzymatic foods are good for digestion)
1/4 c. mixed fruit (any variety)
1/3 c. whole milk
1/8 c. canned coconut milk
1/2 Tbsp. olive oil
1 Flintstones multivitamin

Lunch:
1/8 c. steel cut oats (cooked)
1/8 c. multigrain baby cereal
1/4 slice wheat bread
1/8 c. prune juice (more constipation management)
3 Tbsp. (3/16 c.) carrot or squash (low cal orange veggies)
1/4 c. peas (high cal green veggie)
1 Tbsp. avocado puree (just all around good for you!)
1/4 jar baby food meat (any variety)
1/4 egg
1/8 c. Trader Joe's full fat greek yogurt
1/6 c. whole milk
1/4 Tbsp. olive oil

Dinner:
1/8 c. steel cut oats (cooked)
1/8 c. multigrain baby cereal
1/4 slice wheat bread
1/8 c. prune juice
3 Tbsp. (3/16 c.) green beans, spinach, or broccoli (low cal green veggies)
1/4 c. yam (high cal orange veggie)
1 Tbsp. avocado puree
1/4 can salmon (2 oz. can)
1/4 egg
1/8 c. Trader Joe's full fat greek yogurt
1/6 c. whole milk
1/4 Tbsp. olive oil

Snack:
1/8 c. steel cut oats (cooked)
1/8 c. multigrain baby cereal
1/2 slice wheat bread
1/8 c. apple or pear juice
1/8 c. mixed fruit (any variety)
1/4 c. Trader Joe's full fat greek yogurt
1/3 c. whole milk

While we could mix this up daily, we don't due to time constraints and the fact that this recipe yields too much food per meal for him to handle at once. We find this out by tracking his throwing-up threshold. Trial and error can be messy. Anyway, we make up a quadruple batch of each meal at a time, and divide it into five containers, effectively giving us an 80% recipe. Since we use such high calorie items, he's still getting 1074 calories per day (including the nighttime feed below).

These four feeds don't quite make up everything he needs; we're still working on increasing his volume tolerance, so he also gets a nighttime bolus feed that is set at half the rate of daily feeds to make up the difference. I just recently moved some of the nighttime food over to his daily recipes, so here's where we are right now:

Night Feed:
1/4 c. Trader Joe's full fat greek yogurt
1/8 c. canned coconut milk

All our blends do tend to be a little bit too thick for the pump to handle, especially when they're fresh made, so we thin them out with a small amount of milk when we're ready to feed. This has the added benefit of increasing the calorie count and giving him more calcium. We usually freeze our blends once they're made and thaw them out the day before they're needed.

While tubefeeding is not ideal, and we hope to move beyond it someday, it does allow us to feed him quite a nutritious balance of foods every single day!