Allergy‐Aware Protocol for Blenderized Tube Feeding Initiation in Children With Severe Motor and Intellectual Disability

BACKGROUND: Blenderized tube feeding (BTF) provides nutritional and psychosocial benefits for children requiring long-term enteral nutrition. However, BTF has been reportedly associated with food allergies, including anaphylaxis. Standardized protocols that consider food allergies in BTF initiation are currently unavailable for children with severe motor and intellectual disabilities (SMID). Thus, this study aimed to develop a structured, allergy-aware BTF initiation protocol tailored for patients with SMID receiving exclusive enteral nutrition. METHODS: This research included eight children with SMID (mean age, 4.9 ± 4.1 years; range, 1.4-12 years) relying on exclusive enteral feeding (infant formula or polymeric formula) without a history of food or drug allergies, although one of them had asthma. Seven high-risk allergenic foods, which were selected from 11 most frequently implicated in anaphylaxis in Japan, were incorporated in small, graded amounts into a mixed paste (MP). Initial food challenges using MP were conducted, followed by daily MP administration based on a structured progression modeled after Japanese complementary feeding guidelines. Food-specific challenges were repeated at each stage for over 6 months until successful transition to a standard institutional BTF. RESULTS: All eight participants completed the protocol without any severe allergic reactions. Through the MP-based staged protocol, each successfully transitioned from formula-only feeding to full BTF. CONCLUSION: This novel allergy-aware BTF initiation protocol may be safe and feasible for children with SMID. It provides a model for institutional settings, enabling a safer, stepwise introduction of high-risk foods. This protocol may support BTF implementation in medically complex pediatric populations.