Sandwiches for a 4 year old, help please *blended diet*

[Ratfinkstinkypink]

How many slices of bread do you use? One or two? I want to be sure I am not under/over feeding my little one now he's starting school. He's entirely tube fed and is preverbal so I can't ask him if he is hungry or if it's too much when I send him off with his packed lunch every day.

[Title edited by MNHQ at OP's request]

Would he leave it if it was too much?

If so, start with 2 slices, and move to 1 if half (or more) regularly comes home.

I think, depending on the child and what else is in the lunchbox, either could be correct.

My just turned 4 year old would eat 2 slices of bread if not too much other food in the lunchbox. If you’re including crisps etc then probably 1.5 slices of bread (3/4 of a sandwich). I agree you should start with 2 slices.

If he entirely tube fed, how come he is now eating sandwiches? Sorry if that's a stupid question but I don't understand, would you mind explaining a bit more... assuming he can physically eat the sandwiches then why not do 2 slices the first few times and if he doesn't eat it all you can adjust.

He doesn't eat at all, his food is blended then fed via his tube directly into his stomach. (Sorry I was trying to do two things at once and didn't explain myself well)

Ah I see. And I guess you don't usually make sandwiches for him; he would have freshly prepared meals at home. So you have quantities that work at home but not sure what will work in the new setting (specialist school?? Or mainstream with support?)... does he have a paediatrician or other healthcare professional who can advise?

For a 4 year old, I think 1 slice of bread (half a sandwich) with other things. I assume he’s not just eating a sandwich.

Bless him
Personally I would do once slice cut in fingers
Or you could spread filling on one piece
Cut in strips and roll into " pinwheels"
I used to do pinwheels to tempt mine if they were unwell

The restriction on how much he eats at school, is it going to be a time constraint or how much he can fit in his tummy?? Presumably a member of staff will be helping him have the feed? How quickly does the feed go in? What would he normally consume at home? You would be aiming for him to eat similar. 4 year olds at school tend to eat very little in my experience, god knows why they’re not hungry! BUT they are eating that through self feeding, biting, chewing etc. How much they consume is dictated by how fast they put it in their mouths and how much they can be arsed to eat.
You’re not in quite the same position I don’t think??

Given all food is blended, don't bother with a sandwich.
Feed him what you currently have for lunches, and know is right for him.

What would you normally feed him?
I imagine once blended bread pretty much breaks down to starch/sugar there might be a better alternative to avoid the stodginess and energy peaks and troughs. Sandwiches are a convenient food to hold the filling in place and easy for little hands to manage but that's not a issue here
Maybe couscous/quinoa or similar which has a higher protein content

I probably wouldn't do bread in a blended diet op. It isn't the healthiest food and is really in packed lunches for convenience and bidability of kids.

Stick to what you know and agrees with him. Bread is fairly empty calories for bulk.

If you really want to do sandwiches, then id experiment with volume of bread and fillings with volume of liquid needed and how much volume his stomach can normally tolerate.

To actually answer, my four year olds eat a whole sandwich and my 9 yr part tube fed child has half.

@Veronicabottoms
Why do you think my post is inappropriate?
I answered the OPs question!

The OP has explained that her child is tube fed. What would be the point of making bread into pinwheels or fingers when the food is going to be blended and fed via a gastrostomy tube (also known as a G-tube)?

At 4 I wouldve made mine a whole sandwich (2 slices of bread) and then some days they would have devoured the whole thing and other days pulled the filling out and declared they hate sandwiches.

Or have one bite because they’re so desperate to go play and then eat the rest of the lunch on the way home from school.

Do you have volumes that he normally eats for tube feeding? Will you send the food pre blended? How do you know currently when he’s had enough food? I’m sorry I don’t know exactly how it works.

I’d probably over prepare at first and then see how much of it he eats, and then adjust the portions going forward.

If he's completely tube fed, I'd stick to what he usually has for lunch.

Thank you for the help, to answer a few questions

Although supportive of a blended diet his dietitian isn't the greatest of help and can take a few weeks to answer questions. His usual volume is 240mls over 30-60 minutes depending on how well he's tolerating food, lunch is usually his trickest meal of the day as it's the one that he tolerates worst so I don't want to overdo it as it leads to him vomiting. I usually give avocado at lunch for good calories but it seems to thicken as the day goes on. School will feed him but they won't thin the feed if it thickens as they are still waiting for training on how to blend from the dietetic team, his blends need to be at the consistency of single cream. We are hoping the training will happen soon as then he can just have blended school dinners. Lunch at home would normally be soup with porridge oats/oat cakes or avocado with cream cheese and that but again I find it can thicken as it cools. At the moment I send in 4 x 60mls pre-filled syringes of food I have blended at home, school have asked that we avoid things that need reheating, asked for no meat and nothing that needs to be refrigerated.

Couscous and quinoa are good ideas, I will get some and blend to see how they react to be kept in a syringe for up to 6 hours before feeding.

Oh crikey OP. I wonder if you'd get people with more experience of this if you moved your thread to the SEND board?

www.mumsnet.com/talk/special_needs

As a temporary fix, would you consider one of the ready made products that are available until school has training on blending food? You would still need the dietician to prescribe but you and school wouldn’t need to worry about consistency or volume (the dietitian would calculate volume based on calorie needs). I understand why this might not work if the dietitian is slow to get back to you and also if you’re unsure if he’d tolerate the product.

@Ratfinkstinkypink yes try the SEN board, youll get great help over there.

Are you close to school? Would it work to pop in at lunch time for the time being until they have the training or would that not work with your day and other commitments. I grew up with my back garden overlooking the school field so appreciate not everyone lives that close, or of course have work or other things to do

Sadly I am based an hour away otherwise I would go in.

I will investigate the idea of ready mades, thank you

If you are looking for ready made blended meals rather than prescription feeds, look at Wilbo’s Blends.

We find bread doesn’t work with DS1 no matter how much fluid is used to blend/how thin the liquid is.

Have you thought about your normal soups but with added meat &/or sweet potatoes/potatoes? With added avocado oil rather than avocado itself or olive oil. Or something like roast chicken, boiled sweet potatoes (sweet potatoes thicken less than white potatoes IME) and vegetables (with fluid for blending obviously).

Thank you, I have looked at Wilbo's Blends and I think that might be the way to go in the short term. I can't use meat as school have asked that no meat be sent in as they are worried about the storage of the feed. The info about sweet potato is helpful, how much oil do you add to meals? Our dietitian is lovely but her advice is "Just feed him what you'd feed any child of his age" which isn't really helpful when I am trying to pack calories into relatively small volumes.

The school is being too cautious. Meat will be perfectly fine. You could use a soup flask. I don’t measure oil (nor things like free from butter or cream). DS1 needs a high fat diet because of a medical condition so extra fat isn’t a problem for him. For your DS, I would start with a teaspoon of oil. Then work up from there if DS tolerates it.