Tube-Feeding and the Ketogenic Diet

feeding_tubes_bannerThe ketogenic diet can be much easier to manage when your child is tube-fed since the diet can be given with a special ketogenic formula. In addition, research suggests that an all-liquid ketogenic diet may even be more effective, perhaps because there is less room for errors with measuring foods[1].

Tube-feeding can be given in a variety of ways. Whether given via a bolus, syringe, or feeding pump, the ketogenic diet can easily be given with a feeding tube. Ideally, the feeding schedule should be similar to the way your child was previously fed, just with the new formula.

As usual, the ketogenic diet will be started in the hospital under close medical supervision. You will work with your doctor and dietitian to determine the appropriate ketogenic diet ratio and amount of formula you should give to your child daily. Oftentimes your child will be gradually transitioned from their previous formula to the new ketogenic formula over a period of a few days. While in the hospital for diet initiation, your ketogenic diet health care team will teach you everything you need to know about preparing, administering, and managing your child’s new ketogenic diet when you go home.

KetoCal is a nutritionally-complete ketogenic formula that can be used to provide the ketogenic diet for tube-fed children. It comes in a 3:1 or 4:1 ratio, and as a ready-to-feed liquid or easy-to-prepare powder. KetoCal is milk-based so it may not be appropriate for children who have milk protein allergies. However, your dietitian can put together a modular ketogenic tube-feed with a variety of ingredients that are safe for your child’s food allergies. The KetoCal 4:1 powder and KetoCal 4:1 LQ are both low in lactose, so they are usually okay for children with lactose intolerance.

Tips for Tube-Feeding KetoCal:

  • KetoCal LQ Unflavored is the ideal formula for tube-fed children because it is ready-to-feed. No need to mix! Just shake and administer the formula! In some cases, your child’s dietitian may recommend adding extra water or other ingredients to the formula, so be sure to follow these instructions carefully.
  • If your child is using the KetoCal powder, be sure to mix your formula per the instructions given by your child’s dietitian. For best results, be sure to mix with the correct temperature of water to allow the formula to dissolve fully. It is recommended to use water between 113-122 °F. For more information and tips on mixing KetoCal powder, check out our KetoCal mixing video on YouTube!
  • Once the powdered formula is mixed, store in a closed container in the refrigerator and use within 24 hours. Discard after 24 hours and mix a new batch. Be sure to mix or agitate the formula just prior to feeding since some settling may occur.
  • Once the KetoCal 4:1 LQ has been opened, it can be stored in a closed container in the refrigerator for up to 24 hours.
  • For both the KetoCal Powder and KetoCal LQ, the recommended hang time is 4 hours. The hang time refers to the amount of time the formula can safely remain at room temperature after preparation.
  • Some settling of Ketocal may occur in the feeding bag which is a normal feature of the product. This settling should not block the feeding tube, however, it is recommended that the tube is flushed with water between each feed. It may also help to occasionally agitate the feeding bag.

If you have any questions or concerns, contact your child’s health care team for assistance. For questions about KetoCal, you can also call our Nutrition Services support line at 1-800-365-7354, Option 2.

For assistance with getting insurance reimbursement for KetoCal, contact our Nutricia Product Coverage Navigator program.

Ellen

[1] Kossoff EH, McGrogan JR, Freeman JM. Benefits of an all-liquid ketogenic diet. Epilepsia. 2004 Sep;45(9):1163.

 

Hidden Carbohydrates in Non-Food Products

Toothpaste can be a source of hidden carbs

Toothpaste can be a source of hidden carbs

When your child is on the ketogenic diet, you have to count and limit the carbohydrates (carbs) in everything consumed, not only in foods but also in non-food items. The term “hidden carbs” refers to carbs in products that are easily overlooked because you may not expect these products to contain carbs, or because carbs are listed on the ingredient list in unfamiliar names. Even a small amount of extra carbs can affect the ketogenic ratio, so it’s important to watch out for carbs that may be hiding in unexpected places. In today’s post, we’ll talk about some common non-food items that may be sources of hidden carbs.

Medications

Medications are often made with fillers that may contain carbs. When your child is started on the ketogenic diet, the neurologist and dietitian will assess the carb content in your child’s prescribed medications and switch to carb-free or lower-carb versions if possible. The ketogenic dietitian will account for any carbs coming from medications when calculating your little one’s total daily carb intake.

If your child needs a new medication while on the ketogenic diet (for example an antibiotic for a new ear infection or an antihistamine for seasonal allergies), be sure to contact the neurologist or ketogenic dietitian. If the medication contains carbs, they may be able to recommend a keto-friendly alternative, or if not, adjust the diet to account for the additional carbs coming from the new medication. This applies to situations where you are just switching brands of medications or switching from a brand to generic version and vice versa. Different brands and generic versions can have different ingredients and fillers, so never assume that one version is safe because the other was.

The Charlie Foundation provides a helpful list of Carb-free or Low-Carb products, including common over-the-counter medications, such as:

This list is a great guide for keto-friendly products but as always, consult with your health care team before introducing any new medications.

Personal Care Products:

It’s also important to look out for hidden carbs in personal care products because they may be absorbed through the skin. Be especially careful with dental care products, like toothpaste and mouthwash, as well as skin care products that are applied in large amounts, like sunscreen or body lotion.

Before using personal care products, check the ingredient lists closely to check for hidden carbs and consult with your health care team. Unfortunately, identifying carb sources on the ingredient list can be tricky since they are usually listed in unfamiliar names, like “glycerol” or “propylene glycol”. The Charlie Foundation provides this list of carbohydrate and non-carbohydrate ingredients, which is a great resource because it lists the names of carb sources as they might appear on the ingredient list.

Your health care team may be able to recommend certain brands or varieties of personal care products that are keto-friendly, along with varieties to avoid. The Charlie Foundation’s list of Carb-free or Low-Carb Products includes a broad collection of keto-friendly personal care products, such as:

Remember, if you are ever unsure if a product is keto safe or not, hold off on using it until you check with your health care team.

Keto parents- Have you ever discovered hidden carbs in an unexpected place? Please share your experiences and tips with other parents in the comment section!

Mallory

 

Photo: Flickr

Back to School on the Ketogenic Diet: Part 3

ketoschoollunchFor the final post in our Back to School on the Ketogenic Diet Blog Series, we’ll talk about getting KetoCal® through the National School Lunch Program. We’ll also share some school lunch recipe ideas incorporating KetoCal®LQ. In case you missed them, be sure to read Part 1 on notifying the school about the ketogenic diet and Part 2 on packing the ketogenic diet lunchbox.

KetoCal and the National School Lunch Program

If your child attends a U.S. public school, you may be able to get KetoCal LQ provided by the school for the cost of the standard lunch meal. The Rehabilitation Act of 1973, the Individuals with Disabilities Education Act, as well as the regulations governing the National School Lunch Program (NSLP) stipulate that substitutions to the regular school meal must be made for children who are unable to eat school meals or have special dietary needs due to a qualified disability, such as epilepsy, when that need is certified by a licensed physician. Best of all, our Nutricia Product Coverage Navigator can guide you through the steps to request KetoCal from the school. For more information, visit our Epilepsy and the School Lunch Program webpage.

Quick & Easy KetoCal School Lunch Recipe Ideas

Speaking of KetoCal and school, we are excited to share some ketogenic school lunch recipe ideas that incorporate KetoCal LQ. If your child gets KetoCal LQ provided by the school, you can just send the additional ingredients to go along with it. We hope that your keto kids love the recipes and we hope they save you precious time in the morning!

As always, be sure to consult with your child’s health care provider about all meal ideas to ensure that they work for your child’s specific ketogenic ratio and calorie requirements.

Thanks for reading our Back to School on the Ketogenic Diet Blog Series. We hope everyone has a happy and healthy school year. We’d love to see photos of your little ones and their keto lunches on the first day back, so please share on our Facebook page!

-Mallory