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Food preparation​

Good food hygiene starts before the food reaches the blender.

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• Wash hands thoroughly and frequently during preparation.

• Use clean preparation surfaces and equipment.

• Keep raw and cooked foods separate.

• Check that ingredients are within their use-by dates.

• Cook foods thoroughly, as if they were going to be eaten orally, before blending.

• Take particular care with foods such as meat and poultry.

• A food thermometer can be useful when checking cooking temperatures.

• Blend food thoroughly and achieve a consistency suitable for the child's tube and method of administration.

• If batch preparing, refrigerate or freeze the blend as soon as possible.

• Label containers with the child's name where appropriate, the date/time prepared, ingredients and use-by date.

Cleaning equipment

Blenders, utensils, containers, syringes and extension sets all need careful cleaning.

Equipment used to prepare and administer blends should be washed in warm soapy water, rinsed thoroughly and allowed to air dry, or cleaned according to the manufacturer's instructions.

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Storing blended food

If a blend is not going to be used soon after preparation, it should be stored safely.

Refrigerator

The BDA Practice Toolkit recommends:

• ​Fridge: below 5°C

• Use within 24–48 hours

• Store in a clean, sealed container.

• Keep blends above raw foods to reduce the risk of cross-contamination.

The BDA recommends 24–48 hours. Interestingly, research by Milton et al. found little microbial growth after 48 hours when blends were stored at approximately 4°C using safe food-handling procedures.  However, I would regard it as safer to stick to the 48 hours maximum in a standard refrigerator.  

Freezer

• Freeze at below -18°C.

• The BDA gives 1–3 months, depending on the ingredients.

• Defrost thoroughly in the refrigerator.

• Once defrosted, use within the recommended refrigerated storage period and discard any remaining food afterwards.

If you are batch preparing, freezing individual portions can make feeding much easier and reduces the amount of food repeatedly taken in and out of the refrigerator.

Transporting blended food

When blended food needs to travel to school, nursery, respite or another care setting, it needs to remain cold until it is required.

A cool bag with an ice pack can be useful for transport. On arrival, the blend should be refrigerated promptly.

Agree beforehand with the care setting:

• how the food will be transported;

• where it will be stored;

• how it will be brought to a suitable temperature;

• how it will be administered;

• what equipment will be used; and

• what should happen if the blend is unavailable or cannot be given.

This is particularly important when food is moving between several different care settings.

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Reheating and warming

Not every blend needs to be reheated.

The BDA recommends that blends containing meat, poultry or previously cooked foods are reheated thoroughly to 70°C for at least 2 minutes, or until steaming hot throughout, before being allowed to cool to a suitable temperature for administration.

For blends that do not contain these foods, the BDA gives alternatives such as allowing the container to stand at room temperature for around 30 minutes, or placing the sealed container in hot water for no more than 10 minutes.

Warm blends are often easier to administer because warming can reduce viscosity.

Never give a blend that is too hot, and never force a thick blend through a tube or syringe.

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Why is 2 hours often quoted?

There can be confusion around the different times quoted for food storage.

The BDA Practice Toolkit recommends that blended food should not remain at room temperature for more than 2 hours. This is a precaution designed to minimise the opportunity for harmful bacteria to multiply.

Blended food is a moist, nutrient-rich food and, like other perishable foods, can support bacterial growth if it remains for too long at temperatures that allow bacteria to multiply.

The important factors are food, temperature and time. Control the temperature and reduce the time that food spends in conditions where bacteria can multiply, and you reduce the risk.

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But 2 hours is not a magic point at which food suddenly becomes unsafe

The risk does not suddenly change at 2 hours and depends on many factors, including:

• temperature;

• time;

• ingredients;

• preparation and handling;

• storage conditions; and

• contamination during preparation or administration.

A 2020 study of 50 home-prepared blended tube feeds found no substantial increase in microbial counts over 48 hours when feeds were prepared using safe food-handling procedures and tested at preparation, 24 hours and 48 hours.

This does not mean that blended food should be left at room temperature for 48 hours. The study provides useful evidence about microbial stability under the storage and handling conditions used in the research.

The BDA therefore takes the more cautious approach of recommending a maximum of 2 hours at room temperature.

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Why be particularly careful with blended food?

Unlike a commercially prepared sterile formula, homemade blended food is not sterile. There are opportunities for contamination from ingredients, hands, preparation surfaces, blenders, containers, storage and administration equipment.

Hot weather is another reason to be particularly careful, because bacteria can multiply more quickly at warmer temperatures.

Keeping blends cold when they are not being used, and limiting the time they spend at room temperature, is the safest approach.

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Administering blended food

The method of administration needs to be appropriate for the individual child, the consistency of the blend and the tube being used.

The BDA suggests:

• A gravity bolus method is suitable for thinner blends.

• A slow plunge using an appropriate enteral syringe may be suitable for thicker blends.

• The rate of administration should depend on the child's individual tolerance. Starting slowly and increasing gradually can be helpful.

• Whether an automated feeding pump can be used for blended food should be agreed with the child's clinical team and the equipment manufacturer. The BDA recommends that a blend should not remain at room temperature for more than 2 hours, including when delivered by pump.

A blend should always flow easily. Never use excessive pressure to force food through a tube.

Tube size, consistency, equipment and individual tolerance all matter.

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What about overnight pump feeding?

The 2-hour recommendation can make overnight pump feeding with homemade blended food difficult.

This is one reason why feeding arrangements need to be discussed individually with the dietitian and enteral feeding team. Some children may use a combination of blended food and commercial formula, while others may have a different feeding pattern.

The BDA's 2-hour recommendation is deliberately cautious. It is designed to minimise the opportunity for bacterial growth rather than suggesting that a blend suddenly becomes unsafe at exactly two hours.

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My own approach to food safety

Personally, I believe the safest way to use blended diet is to be scrupulous about preparation, storage and temperature.

Food choice matters too. I avoid some foods where I feel the risk is unnecessary — for example, I don't use lettuce in blends because of the potential for contamination even when it has been washed.

We batch cook, blend within about half an hour and freeze the portions immediately. Alternatively, blends can be kept refrigerated when they are going to be used within the recommended storage period.

We defrost food overnight in the refrigerator and allow it to come towards room temperature before giving it.

For me, the important point is not simply to remember a number such as "two hours". It is to understand food, temperature and time, and to keep the whole process as safe as possible.

A food hygiene course can be very useful because it helps you understand why these precautions matter.