Who is suitable for Blended Diet?

Step 1

Not every child or adult is suitable for Blended Diet however, with care, many people can be fed a food based diet after suitability and tolerance is established. Even a mix of food and formula can be beneficial. A gradual build up is required and its important that hygiene standards are kept high.

Getting Started

There are several factors to consider when starting BD. The advice here is aimed at children with naso gastric tubes or gastrostomies and a normal digestive system insofar as they don't have short bowel syndrome or serious malabsorption problems. J tubes and Jejunal feeding is more complicated. There is currently limited evidence and healthcare professionals in the UK are reluctant to endorse a method that could have serious adverse affects. Discuss this specifically with their specialist team as research is ongoing and this may change in the future. If the J tube has a gastric port it's usually safe for food, but always discuss as the lumen may be narrower.

Step 1

Is Blended Diet Right for My Child?

Not every child is suitable for blended diet, but many tube-fed children can use some or all of their nutrition as blended food when it is appropriate for them.

Blended diet can also be used alongside commercial formula. There is no requirement to make an all-or-nothing change.

The first step is to consider whether it could be suitable for your child.

Start with your clinical team

Things have changed considerably since Elliot started blended diet. The BDA now recommends a shared decision-making approach, with the dietitian leading discussions with the wider clinical team.

Your dietitian can help consider your child's nutritional and medical needs, tube type, feeding pattern, medicines and any particular risks.

You don't need to have all the answers before you start the conversation. That's what your clinical team is there for.

What type of tube does your child have?

The type and size of feeding tube matter.

A gastrostomy is generally the preferred tube for blended diet. The BDA advises that blended diet can sometimes be given through the gastric port of a gastro-jejunal tube, but the narrower jejunal extension can make this more difficult.

Blended diet is not commonly used through nasogastric tube as they are usually tiny and used on babies, but it is possible with care. J Tubes are generally considered less suitable than gastrostomy feeding. Discuss the reasons with the clinical team before even considering this.

Your clinical team should also check the manufacturer's instructions for the particular tube and equipment being used.

The BDA suggests that a tube of around 12 French or larger is preferable, although smaller tubes can sometimes be used with a thinner blend and appropriate care. 14 is considered easier.

If a gastrostomy has recently been inserted, it's better to delay BD as it needs time to heal and mature in case a blockage occurs, it may need changing. Your clinical team will advise when it is safe.

How soon can blended diet begin once the tube is in?

It's recommended 6-8 weeks to allow for the wound to heal and a tract to form, although healing can take place sooner in some. A tract is a little tunnel between the stomach and the abdominal wall. It fixes a small portion of the stomach to the abdominal wall. Once healed blended diet can start. Should the tube fall or be pulled out the hole can begin closing after 1-2 hours so it's vital you seek help or put in a new button. You are given training on what to do in this case.

Things to Consider when Starting BD

Good food hygiene

Good food hygiene is essential.

You aren't trying to make homemade food sterile, but you do need to understand how contamination can occur and how to minimise the risk.

Clean hands, clean preparation surfaces, appropriate storage, safe cooking and careful handling all matter.

I've put the detailed information about food preparation, storage, transport and administration on a separate page because there is quite a lot to know.

[Food Safety, Storage & Administration →]

If you're new to food hygiene, an online Level 2 Food Safety & Hygiene course can be useful. I did one myself and found that it increased my confidence and understanding.

Important medication issues

Food can affect the absorption or action of some medicines.

This is particularly important for medicines where blood levels need to be carefully controlled, including some medicines used to treat epilepsy.

If your child takes medicines that require monitoring, speak to the prescriber, pharmacist or clinical team before changing their feeding method. They can decide whether any additional monitoring is needed.

Don't assume that because a medicine has always been given with formula, nothing needs checking when the feeding method changes.

Blending food

A way of blending to a fine smooth paste, the consistency of thick batter, which will go through the tube. Most people start with a hand blender, a normal speed blender and a sieve. The sieve is essential to begin with. You may find some foods like baby porridge or Ella's kitchen purees need no sieving. However the time comes when you need the high speed blender and they can be between £250-800. Some manufacturers like Blendtec, give a discount so always ask. Some charities will fund, or local fundraisers. Its something that makes life much easier and keeps all the ingredients and leaves nothing in a sieve.

Good nutrition

Blended diet isn't simply a matter of putting ordinary food into a blender.

If blended food is replacing a significant proportion of your child's formula, the diet needs to provide enough energy, protein, vitamins, minerals, fluid and other nutrients for your child's individual needs.

Your dietitian can help you work out appropriate foods, portions and supplements.

A food diary can also be very useful when you're starting. It allows you and your dietitian to see what your child is eating, what they tolerate well and whether anything needs adjusting.

Facts

This is what this website should give you. Not just the basics and a shove in the right direction. Truthfully though, its better to have your dietician on your side and fighting your corner. Luckily they are mostly reasonable people and would be doing the same thing in your position.

Be patient

There is no single timetable for starting blended diet.

Some children can begin with small amounts alongside their usual formula. Others may move more quickly, particularly if they previously ate normally by mouth.

For some children the change is gradual over several weeks.

There is also no need to rush towards completely replacing formula. A combination of blended food and formula can be a perfectly sensible long-term feeding plan if that works best for the child.

Some children continue to need overnight feeds, higher-energy formula or additional supplements.

Your child writes their own manual.

Don't be nervous

Starting something new through a feeding tube can feel quite daunting.

But once you've learned the basics, blended diet is still just food — prepared carefully, blended appropriately and given through the tube.

Start slowly, learn what works for your child and ask for help when you need it.

You don't have to work everything out on your own.

And remember: what works brilliantly for one child may not work for another.

When to start

Ideally discuss BD with your dietician and care team before starting, especially if you feel they are sympathetic to a parent's need to feed their child as they feel is best. Things have changed considerably over the years, and shared decision-making is now an important part of the approach to blended diet. Even if they are sceptical to begin with, they can't argue with a child who looks suddenly well, is not vomiting so much, and gaining weight.

Before you start checklist

It is useful to have discussed the following with your clinical team:

Is blended diet appropriate for my child?
Is their feeding tube suitable?
What consistency is appropriate?
How much blended food should they receive?
Which foods and supplements are needed?
Could any medicines be affected?
How should the blend be prepared, stored and transported?
How should it be administered?
What should we do if the tube blocks?
How will my child's weight, growth and nutritional status be monitored?
What happens if my child becomes unwell or needs to go into hospital?

You don't need to know all the answers before starting the conversation.

The important thing is to have the conversation.