Improving Weight Gain in Children Fed by Feeding Tube: Exploring New Approaches

Hearing that your tube fed child is underweight despite your hard work can be really hard for any parent. The days before the appointment are full of worry, expecting a disappointing talk about your child not gaining enough weight. It can make you feel like you’re always coming up short, even though you’re trying your best.

You’re following the recommendations, increasing the amount of tube feeds, slowing down feedings, changing formulas, but you feel like these efforts only make things worse. The constant cycle of trying new medications, dealing with pharmacies, and struggling to find time for everything is taking its toll on you.

Acknowledging Factors Beyond Your Control

Let’s talk about something important: many things affect your child’s growth besides their tube feedings, and it’s essential to know that slow growth doesn’t mean you’re not a good parent.

hilarie dreyer


Not getting enough nutrients can happen for reasons beyond your control, like digestive issues (vomiting, reflux, slow digestion), being sensitive to textures or oral aversion, or even genetics or sickness. These issues can make it hard for your child to get the nutrition they need for healthy growth. And if they need to catch up on growth, it’s an even bigger challenge.

It’s important to remember that you are not failing your child! Despite feeling like you’ve exhausted every option, I am here to offer you an alternative solution: blending real food for your child’s tube feeds.

The Power of a Real Food Blended Diet

During my 8 years as a pediatric dietitian, I’ve helped lots of parents deal with challenges when their kids struggle with tube feeding. Many of these families found relief by switching to blending real food for their child’s tube feeding. Soon after, their child began to feel better, experienced fewer issues like vomiting and reflux, and could handle more food. This improvement even led to better growth for their child! Learn more about navigating digestive issues with real food here.

This new way of tube feeding also offered them more flexibility. Unlike relying solely on commercial formula, which usually involves increasing volume or changing the formula to boost calories, these parents were able to optimize weight gain by incorporating high-calorie and nutrient-dense foods into their child’s diet.

They regained some control and could now make a direct impact on their child’s growth and well-being! They felt confident and empowered, being able to choose what to feed their child without constantly seeking advice.

fruits and vegetables on a table

This method, often called blenderized tube feeding, has become more popular among families who tube-feed at home. And contrary to some misconceptions, research shows that it can have a good effect on the digestive health and overall well-being of kids who receive their nutrition via feeding tube.

Wondering how to begin giving real food to your tube-fed child? This step might seem challenging, especially if your medical team is not sure how to support you. But don’t worry, you don’t have to navigate this alone.

Blended Tube Feeding Made Simple takes away the big learning curve and offers support through each step, making it easy to try real food. Inside you’ll find a large database of recipes so you don’t have to think about what to blend, you’ll quickly become confident you can do this!

Optimizing Your Child’s Tube Feeds for Better Growth

In my experience, many children fed by feeding tube face challenges when it comes to taking in larger amounts of tube formula. This often happens due to ongoing digestive issues that require a slow and gradual delivery of the formula, in small portions, to prevent any discomfort or problems. This can lead to the stomach not expanding as it typically does with meals given more quickly.

a green blended meal in a cup

This can slowly start to improve with the switch to using blended, real food for their nutrition, but it can take time for the stomach to comfortably stretch out again. Because of this, it’s important to maximize calories and get as much nutrition as possible in a small volume of food.

The best way to do this is to blend high calorie, nutrient dense foods. And to help easy any overwhelm you may be feeling, I’ve compiled a list of foods to incorporate into your child’s blended tube feeding meals.

Please remember that not all these foods may be suitable for your child, particularly if they are on chronic medication, have food allergies, or any medical condition that contraindicates the use of certain foods. It’s important to consult your child’s dietitian or doctor before introducing new foods into their diet.

Blended Diet: Energy-Rich Foods in Each Food Group

Whole Grains

Foods that contain whole grains and lots of carbohydrates are high in calories and are a great way to help your child gain weight. For some children, adding more carbs to a blended diet has been more successful in helping them gain weight than adding more fat. Whole grains also contain necessary nutrients and minerals to help your child have adequate energy and develop well. 

a woman holding quinoa, bread, and grains in a basket
  • Cooked Grains (Quinoa, Rice, Millet, Buckwheat or Amaranth)
  • Homemade Granola (Avoid Nuts/Seeds with a standard Blender)
  • Cooked Whole Wheat Pasta
  • Cereals
  • Oatmeal (Best to Let Soak in Liquid First)
  • Whole Grain Bread (Look for Ones With <100 Calories Per Serving)

Tip: Keep in mind that starches tend to thicken blends quite a bit, and as time goes by, they tend to thicken even more as the starch absorbs more fluid! Start with a smaller amount, you can always add more if needed!

Fat/Oil

Foods high in healthy fat are great options for calorie boosting because fat has more calories per gram than protein and carbohydrates and a little goes a long way. However, fat takes the longest to digest and may make your child’s feeding problems worse if you over do it. Therefore, it is important to keep meals balanced, and not just full of fat. 

When you use these items below, it may be best to start with a small amount and gradually add more as tolerated. Oil tends separate from the rest of the blended food after sitting for a while. You may need to re blend if the meal is not fed right away, otherwise the oil sticks to the tubing or feeding bag and doesn’t actually get fed to your child.

  • Avocado
  • Oil (Olive Oil, Coconut Oil, Avocado Oil)
  • Nut butters (Peanut Butter, Almond Butter, Cashew Butter, etc.)
  • Tahini
  • Silk Heavy Whipping Cream
  • Flaxseed Powder
  • Chia Seeds
  • Hemp Hearts 
  • MCT Oil
  • Hummus 

Tip: Avocado thickens blends quite a bit, even in a small amount! If you need thinner meals, use a small amount, or opt for other options instead.

Protein Foods

Most protein foods have quite a bit of calories in a small volume of food and are an important part of high calorie, low volume blended meals. Whether you choose to use animal sources or plant sources of protein (or both), adequate protein intake is important to help your child grow well and build strong body tissue. Be sure to change up what protein sources you are using to be sure your child gets a variety of important nutrients!

a hand reaching for a can of sardines sitting with cans of tuna and salmon
  • Salmon
  • Sardines
  • Tuna
  • Hemp Hearts
  • Chicken Thigh
  • Ham
  • Beef Roast/Brisket
  • Tofu
  • Hard-Boiled Eggs
  • Beans 

Fruits and Vegetables

Fruits and vegetables tend to be low in calories, but that doesn’t mean you should skip out on these foods when your child needs a high calorie diet. Fruits and vegetables contain fiber, which is important for a healthy digestive tract. They also contain a ton of vitamins and minerals which are important for growth and development.

Hilarie holding a blended meal in a jar and a bowl of vegetables

Tip: Frozen fruits and vegetables are great to have on hand. No prep, and you don’t have to worry about them going bad quickly!

  • Mango
  • Banana
  • Peaches
  • Pears
  • Shredded Coconut
  • Papaya
  • Dragon Fruit
  • Artichoke
  • Green Peas
  • Squash (Butternut, Acorn, Pumpkin Puree)
  • Potato (Sweet, Red, White)
  • Other Root Vegetables (Parsnip, Beets, Yuka, Rutabaga)

Dairy and Dairy Alternatives

It is very difficult to create high calorie, low volume meals without a high calorie liquid base. Using dairy and dairy alternatives in blended meals can really increase the calories, especially when you choose full fat options! By including the below items, you’ll also provide some protein as well as calcium, vitamin D and vitamin B12. 

  • Whole Milk
  • Whole Milk Greek Yogurt
  • Coconut Milk Yogurt
  • Ricotta Cheese
  • Cottage Cheese
  • Condensed Coconut Milk
  • Plant-based milks (look for ones that are fortified with vitamin D and calcium)

Preparation and Blending Strategies to Be Successful


To ensure success in creating a high-calorie blended diet, it’s important to have effective strategies in place that work for you and your family. For example, some parents prefer to blend meals on a per-meal basis, utilizing the food they’ve already prepared for the rest of the family.

Others prefer to dedicate a few hours every week to batch blending and freezing meals or ingredients to easily grab and go later. You may find you want to do a combination of things, and that’s okay too.

Hilarie in front of computer

If you feel overwhelmed by the task of deciding what to blend, I have a solution for you: Blended Tube Feeding Made Simple.

Inside the program, you’ll find a large database of high calorie recipes that make it easy to meet nutrition needs and you don’t have to think about what to blend. Plus, you’ll receive a ton of guidance through each step. If you’ve been thinking, I wish someone would just tell me what to do, this is it!

And just imagine the time you’ll get back when your child feels better, you’re cleaning up less vomit, feeding times are shorter…and this usually happens in just a few months!

I hope that this post provides you with hope, reassuring you that things can get better, and that you can successfully provide a high-calorie, blended diet for your tube-fed child.

Take Care and Happy Blending!

~ Hilarie, RD, CSP

*Disclaimer: The information and education provided here is not intended or implied to supplement or replace professional medical advice. Always check with your own medical professional before trying to implement any information provided here

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