Depends. Something like a small sling in a vial where it's difficult to get old food out completely and is being kept constantly moist, I'll change out about every 2-3 months. For an adult, I won't change the substrate out but every 12-18 months.
Semi-regular policing to remove old food boli is the key. Other than that, you don't really need to change it out except as "needed".
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