BLENDED DIET FOR TUBE FED CHILDREN IN THE UK
Facts about Tubes, Buttons and Blended Diet
Parents and professionals may have concerns about correct use of the tubing and equipment used in blended diet. The tubing is very robust and has been tested extensively by the manufacturers however it must be used safely guided by the child's medical team.
Can Blended Diet be given safely via feeding tubes?
Feeding tubes are tested extensively by the manufacturers before being approved by the relevant safety agency for use by patients. Some parents and some healthcare professionals are concerned about the pressure exerted when giving blended food via the tubes supplied by the NHS. However, rigorous testing has ensured the tubes are safe if used correctly and without excessive pressure. Blended food does not automatically mean dangerous pressure on the tube. However, thicker blends and blockages can increase resistance, and different tubes, buttons, extension sets and pumps have different specifications. Never force a blocked tube. The BDA says administration is likely to be easier with some devices than others. The manufacturer's instruction for use (MIU) leaflet should be consulted if there are concerns. Training will always be given if you have a child with a feeding tube.
The Use of Naso-Gastric Tubes
A report published in the National Library of Medicine in February 2026 warns of the unusually high pressures generated in a paediatric nasogastric feeding tube usually small size (1-3 ml) syringes. This resulted in harm to the baby when the tube ruptured. The only acceptable syringe size is over 30 mls for gently unblocking these tubes. Never use force. If you are considering giving BD via an NG tube always inform your child's medical team. Check before every feed it's correctly situated. Give BD the same consistency as formula. Always sieve to prevent blockages. If a blockage occurs use a large syringe and the method taught by your dietitian to unblock it. If it's resistant to gentle unblocking, replace the tube as taught.
Nasogastric tubes are the most problematic when giving BD but under clinical guidance, they can be used safely.
Blockages in other Tubes
Should a feeding tube block (button or PEG tube) use the same techniques.
The Initial PEG tube (Bumper style) is less likely to because of the wide bore and no valves or narrowed areas. However if it does block it requires surgical intervention by the medical team. That is clearly undesirable so sieving and a very good blender may be best. Mickey and Mini buttons are held in place by a water filled balloon and can be replaced by the parent should they become blocked. They have a tiny (size of a raspberry pip) one way silicone valve through which the feed has to travel. The valve can be blocked more easily but the parent can change this at home. They are extremely expensive so try to keep to a minimum the number of blockages. Medication is very often the culprit, although pips are runners up.
Always follow the instructions of the clinical team and the manufacturers information sheet regarding blockages, changes and cleaning. Flushing needs to clear the tube but not overload the child. For infants and children, the appropriate volume is determined by age, size, and individual clinical needs as prescribed by a medical team.
J-Tubes and JG Tubes
J-tubes are longer than a standard tube and go down into the jejunum (part of the small bowel) and bypass the stomach. They are usually put in for a variety of reasons. They are considered undesirable for a number of safety reasons in the UK and it's not advised for traditional blended diet. Physiologically the jejunum is not designed to take large volumes of food as the stomach is. J tubes are often used with continuous feeds meaning long hanging times. This may have implications for BD and food hygiene. Many tubes however also have a G-Port (Gastric Port) as well as the J-port. This does go into the stomach so BD can be given into it. It's quite a narrow lumen however, so a really good blender is essential.
Do the manufacturers of feeding tubes and devices support blended diet?
Generally speaking Tube and device manufacturers support the use of blended diet through their products provided they are used in line with hospital guidelines and support of the healthcare professions. They include GBUK, Vygon, Avanos, AMT and Medicina. In the previous incarnation of my website I listed multiple sources and evidence of this support because the dietetic community was very opposed to BD and when attempting to get our point across, we needed evidence. We don't need it any more. Not only does the British Dietetic Association give their support but so does the Enteral Products Safety Group (EPSG), who represent many of the UK plastic tube manufacturers and suppliers.
How Professional Attitudes Changed
When we started this journey nearly 15 years ago it felt like a wilderness. Faced with a darling boy fading away before our eyes, vomiting and lethargic and not tolerating feeds, unable to eat enough to grow and thrive, blended diet proved our lifeline.
But! The resistance was horrendous. Dietitian, hospital, school, respite, you name it. Made to feel like criminals for wanting to feed our boy but doing it anyway because we saw the results.
Then we met other parents, joined a Facebook group, realised we weren't alone and really pushed. I set up this website because of all the research I needed to do to convince people in authority we were doing the right thing.
Eventually academics and professional associations started investigating the strange idea of feeding children food (albeit in a novel way!). Talks, demonstrations, academic papers and revised policies began emerging. We had to produce all that evidence because nobody would listen, but thankfully the landscape has changed.
And here we are in 2026 with a complete turnaround from the plastics suppliers, the BDA, hospitals and multiple institutions. Even Formula companies are offering a formula containing real food. Formula still has it's place but when the BDA are saying blended diet can be offered as an option, acknowledges potential physiological/social/emotional benefits, and advocates shared decision-making, my work is done.
What does the term 'not licensed' actually mean?
You may hear the term 'not licensed' in the UK in relation to putting food through the tubing and the buttons. Just to reiterate. Food is not licensed because it is not tested not because it is unsafe.
You have to understand that many drugs are not licensed specifically for giving down tubes simply because the years long, rigorous testing needed to ensure safety and efficacy are not cost effective. However common sense tells you a simple drug like trihexyphenidyl (the drug not the name!) which is given to children with cerebral palsy at quite a young age is not specifically tested on them or on the tubing used to give via the gastrostomy.
The same common sense asks what's the major difference between home cooked food and commercially available formula? Formula can be given orally as can food, so why can't blended food be put down a plastic tube? Will it rot plastic or silicone? Obviously not.
Also important to know is that the NHS uses equipment designed and tested for one task for other purposes. Initially we were given an NG tube to insert in the gastrostomy opening if the button fell out, just to keep it open. Tested down noses of course but not gastrostomies specifically.