Tips for Caregivers of Tube-fed Children & Adults on the Medical Ketogenic Diet

Tish and Caroline

My name is Tish and I have a 21-year-old daughter named Caroline. She has a rare neurological disorder called Alternating Hemiplegia of Childhood (AHC), and as with about 50% of kids who have AHC, she also suffers from epilepsy. Caroline has had seizures since birth, but they were pretty well controlled with medications until she hit her teenage years. About 3 years ago, she ended up in the hospital in status epilepticus for over 12 hours. After this event, we decided, with our neurologist, that it was time to try the medical ketogenic diet.

The medical ketogenic diet has been incredibly helpful for Caroline. Not only did it help with her seizures, but we noticed increased energy and overall health. Because Caroline is tube-fed, the medical ketogenic diet is relatively easy to do. Now that we have been doing the diet for a while, I’ve come up with some ways to make it a little easier. I hope that these tips will help make your life a little easier too!

Have Your Tools Handy

Have all the things you need to make your feeds stored in the kitchen by the sink rather than the pantry. You may be giving up valuable storage space but it will take the hassle out of mixing your feeds. I use a deep drawer just by the sink that serves as our “keto drawer”. I keep the KetoCal® 4:1 LQ, all the extra ingredients, gram scale and mixing devices right there.

Pre-make Your Feeds

KetoCal 4:1 LQ mixed in a lidded container with a pour spout

Because my daughter is older, she needs extra protein with the KetoCal®, so we add protein powder, plus MCT oil. I pre-make all my daughter’s feeds the night before and store them in containers in the refrigerator. They are safe to use for 24 hours. I put the mixture in a small lidded container with a pour spout. This makes it easy to take to school or on outings. I just shake them up before pouring them into her feeding bag. I bought the lidded containers at the grocery store. We use 3 per day and I have 6 of them so that I always have a clean set to work with.

Measure Your MCT Oil in a Glass Container

Measuring the MCT oil is a challenge for us. We use a small amount and the MCT oil is hard to clean out of most plastic measuring devices. I like to use a glass shot glass with mL and fluid ounce measurements on it. I bought it at a kitchen store but you can also find them online. (Be sure to check with your dietitian because some families may be asked to measure MCT oil with a gram scale)

Check Off All Your Daily Requirements

When I made my daughter’s feeds, I put everything she needs once daily into her morning feed. So, I put her potassium citrate, powdered multivitamin (we use Phlexy-Vits® by Nutricia) and her daily laxative dose into her morning feed. Just prior to feeding, I add them to the plastic container that I made the night before. This way I am sure she gets everything she needs for the day.

Create Instructions for Other Caregivers

I am usually the one who mixes all food and medicines for my daughter. However, in the event that a caregiver or family member does it in my absence, I have typed, laminated instructions in my “keto drawer” with all of the ingredients and equipment.

I hope that these tips are helpful. If you have a child who is tube-fed and has uncontrolled seizures, I highly recommend that you talk to your neurologist about the medical ketogenic diet. It has been pretty easy to manage, and for us, it has made a big difference in our daughter’s quality of life.

-Tish

*Please note that this is one family’s report of their experience with the ketogenic diet and may not be the experience of others. Individual results will vary. Please discuss the potential benefits of the ketogenic diet with your healthcare provider.

I was paid by Nutricia for my time writing this post, however, my opinions are my own.

KetoCal is a medical food for the management of intractable epilepsy and is intended for use under medical supervision. Talk to your healthcare provider about whether KetoCal is right for you.

The Benefits of Using KetoCal® 4:1 Once Per Day

KetoCal 4-1 productsThe ketogenic diet can help manage seizures in patients with refractory epilepsy. In fact, research shows that just over half of children on the ketogenic diet will have 50% or more improvement in seizures, about 1/3 of children will have over 90% improvement in seizures and about 10-15% will become seizure-free. While it can be helpful with seizure management, being on the ketogenic diet can be challenging at times. In today’s blog post, I will tell you a little about how KetoCal can be a helpful addition to the ketogenic diet.

KetoCal Everyday Convenience

If you have a child on the ketogenic diet, I don’t have to tell you that it can be challenging to plan for keto meals or snacks while running errands, traveling, or going to after-school activities. Using KetoCal once per day can help provide everyday convenience when you are on-the-go. KetoCal® LQ is ready-to-drink and provides a simple and nutritious solution for busy schedules. It also tastes great! (Request a sample to taste it for yourself!)

KetoCal for Nutritional Reassurance

As a busy mom and dietitian, I know a little about the struggle to find meals and snacks that are easy AND nutritious. KetoCal was designed to be both! Using KetoCal® 4:1 once per day is not only convenient, but can also help fill nutrient gaps in the ketogenic diet. Unlike heavy cream (a popular milk substitute with the ketogenic diet)*, one serving of KetoCal 4:1 (356 calories) provides:

  • An excellent source of calcium and vitamin D, two nutrients that are important for bone health
  • Fiber to promote gut health
  • DHA, an Omega-3 fatty acid that plays a role in brain and eye health
  • 4 times LESS saturated fat when compared to heavy cream!

There are multiple ways to incorporate KetoCal 4:1 into your daily routine. You can drink it once per day or use it in everyday recipes. KetoCal 4:1 is available as a powder (great for baking!) or as a ready-to-drink liquid (convenient while on-the-go). Work with your dietitian or visit www.myketoplanner.com to find tasty recipes using KetoCal 4:1.

Ellen Avery, MS, RD
Medical Advisor, Ketogenics
Nutricia North America

KetoCal is a medical food for the dietary management of intractable epilepsy and is intended for use under medical supervision. Talk with your healthcare provider about whether KetoCal is right for you. 

*Comparing an equal amount of calories from heavy cream.

Celebrating “Thanks-Keto-Giving”

Today’s guest blog post is by ketogenic dietitian and Nutricia Keto Ambassador Vanessa Aldaz, MPH, RD, CDE. Vanessa provides her tips and recipes ideas for families celebrating Thanksgiving on the ketogenic diet.


The holiday season is around the corner. Thanksgiving may have a different meaning for each household and how we choose to celebrate it may vary from home to home. However, I believe

thanksgiving 2that one thing most people can agree on is that it is centered around coming together with family, loved ones and friends. Here are some ideas for your keto family to consider when celebrating “Thanks-keto-giving” this year (aka: thanksgiving with a keto twist).

Keto-friendly Recipes:

The following are a few good recipe ideas for you to try. Don’t get overwhelmed with the options or feel that you need to make them all. Two sides and 1 dessert can easily make your keto-child or keto- friends feel included and very “keto-thankful”.

Main Dishes

Choose from an array of protein choices: These main dishes are perfect as most of them are carbohydrate-free.

  • Roasted turkey (not stuffed)- Instead of traditional stuffing, you can stuff with herbs and citrus rinds to give your turkey flavor and holiday flair
  • A “Turducken” (duck stuffed with a chicken stuffed inside a turkey)
  • Roasted whole ham leg or a spiraled ham (without the brown sugar glaze)
  • Non-traditional main dishes such as salmon, lobster or filet mignon

Side Dishes

  • Instead of mashed potatoes, try mashed cauliflower drizzled with good quality butter or try KetoCal® Mashed Fauxtatoes (4:1 recipe, 3:1 recipe)
  • Try the KetoCal Cauliflower and Cheese recipe- sooo good! (4:1 recipe, 3:1 recipe, MAD recipe)
  • Green salads- use group A and B vegetables if you are on the Classic Ketogenic diet. Read the food label of your favorite creamy dressing and add heavy cream, mayonnaise, or oil to make it your ratio. Check your specific diet ratio and amounts with your ketogenic dietitian
    • My favorite: kale and baby spinach, cucumbers and sunflower seeds, topped with blue cheese dressing with extra heavy cream and mayonnaise.
  • KetoCal’s Thanksgiving Stuffing (4:1 recipe, 3:1 recipe)
  • KetoCal’s Green Bean Casserole Recipe (4:1 recipe, 3:1 recipe)
  • Charlie Foundation’s Chicken or turkey keto gravy (3:1 recipe)
  • Charlie Foundation’s Squash Curry Soup (if you are not a fan of curry try adding pumpkin spice instead)
  • Charlie Foundation’s High Fiber Bread Roll (4.16:1 recipe) (you can also use these high fiber rolls as a base for stuffing)

Desserts:

Family Activities

Another way to make “Thanksketogiving” a success is to try not to completely focus the day around the food. Get up and go do other fun and exciting activities to add to your memories. Depending on where you live there are many holiday activities you can participate in.

Go to the movies!

Thanksgiving weekend is a popular time for opening day of some big movies of the year. There are a variety of movies, animated and not, that feature heroes, superheroes, and other beloved characters of the season. There is something for everyone!

Take a walk!

Weather permitting, it’s nice to get outside as a family. Take a walk around the neighborhood or out to the zoo.  If you live in warmer climates, play touch football, soccer or baseball in your backyard or a nearby park.

Play games!

Get your friends and family together and play charades! Have everyone write random words, famous people, phrases or themes on pieces of paper and put them all in a jar. Make your own rules and have fun as all ages can play this game. Or, if you don’t like charades, family board games are always fun.  If relatives are coming, have them bring some of their favorites so you can all play together!

Play & sing!

If your family likes to sing or play music, consider bringing music sheets or a karaoke machine! You can always use pots, pans and plastic containers that aren’t used for the meal to make musical instruments and form your own band.

Get crafty!

Set out festive craft supplies for your little ones to create placemats, napkin rings, wreaths and centerpieces to use as your Thanksgiving Day table decorations. You can find some Thanksgiving-themed craft ideas here.

And finally, don’t forget to share with each other why you are grateful to be together or what you are thankful for. Happy Thanksgiving, everyone!

-Vanessa

I was paid by Nutricia for my time to write this blog, however, my opinions are my own. 

KetoCal is a medical food and is intended for use under medical supervision. 

The ketogenic diet for epilepsy should be used under medical supervision. 

KetoCal is a trademark of SHS International LTD.