{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T07:12:40Z","timestamp":1778137960687,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":125,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Blenderized tube feeding (BTF) provides nutritional and psychosocial benefits for children requiring long\u2010term 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\u2010aware BTF initiation protocol tailored for patients with SMID receiving exclusive enteral nutrition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This research included eight children with SMID (mean age, 4.9\u2009\u00b1\u20094.1\u2009years; range, 1.4\u201312\u2009years) 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\u2010risk 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\u2010specific challenges were repeated at each stage for over 6\u2009months until successful transition to a standard institutional BTF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All eight participants completed the protocol without any severe allergic reactions. Through the MP\u2010based staged protocol, each successfully transitioned from formula\u2010only feeding to full BTF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This novel allergy\u2010aware 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\u2010risk foods. This protocol may support BTF implementation in medically complex pediatric populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ped.70428","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T06:38:27Z","timestamp":1778135907000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Allergy\u2010Aware Protocol for Blenderized Tube Feeding Initiation in Children With Severe Motor and Intellectual Disability"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9400-590X","authenticated-orcid":false,"given":"Yota","family":"Sato","sequence":"first","affiliation":[{"name":"Nutrition Support Team, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children  Iwate Japan"},{"name":"Department of Pediatrics Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children  Iwate Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuya","family":"Takamasu","sequence":"additional","affiliation":[{"name":"Department of Community Health Promotion Kanagawa Children's Medical Center  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumie","family":"Endo","sequence":"additional","affiliation":[{"name":"Nutrition Support Team, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children  Iwate Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sakura","family":"Matsuyama","sequence":"additional","affiliation":[{"name":"Nutrition Support Team, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children  Iwate Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsuko","family":"Kimura","sequence":"additional","affiliation":[{"name":"Nutrition Support Team, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children  Iwate Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Toda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children  Iwate Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Kamei","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children  Iwate Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jhn.13143"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild\u20102016\u2010310971"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0884533614564996"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ncp.10406"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2019.04.023"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jhn.12563"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0884533615591602"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild\u20102016\u2010311030"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0884533616669703"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/ebnurs\u20102023\u2010103859"},{"issue":"6","key":"e_1_2_11_12_1","first-page":"832","article-title":"Food Allergy Overlooked in a Severely Retarded Child","volume":"65","author":"Nambu M.","year":"2006","journal-title":"Journal of Children's Health"},{"issue":"3","key":"e_1_2_11_13_1","first-page":"253","article-title":"A Case of a Child With Severe Motor and Intellectual Disabilities Who Developed Anaphylaxis After Introduction of a Food Paste Containing Chicken Eggs","volume":"45","author":"Mitsui A.","year":"2020","journal-title":"Journal of Severe Motor and Intellectual Disabilities"},{"key":"e_1_2_11_14_1","unstructured":"O.Kono \u201cA Case of a Child With Severe Motor and Intellectual Disabilities Who Developed Anaphylaxis After Administration of a Protein Supplement. Paper Presented at: 46th Annual Meeting of the Japanese Society of Severe Motor and Intellectual Disabilities \u201d(2021)."},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/pai.14276"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpen.2062"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ncp.11055"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.15036\/arerugi.69.701"},{"key":"e_1_2_11_19_1","volume-title":"Support Guide for Breastfeeding and Complementary Feeding (2019 Revised Edition)","author":"Ministry of Health, Labour and Welfare, Japan","year":"2019"},{"key":"e_1_2_11_20_1","unstructured":"Ministry of Education Culture Sports Science and Technology Japan \u201cStandard Tables of Food Composition in Japan 2020 (Eighth Revised Edition). 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