Advances in medical technology have given rise to many changes in enteral tube feeding over the years. Currently, standard practice in the UK is to use commercial formula for tube feeding via the stomach or small intestine; however, the use of blended diet is becoming more popular. Emerging evidence shows multiple benefits to using blended diet although there is a lack of robust evidence to support clinical guidance. Consequently, there is disparity in practice and it remains unclear which patient groups may benefit most from using blended diet.

This case study is an example of the introduction of blended diet for a paediatric patient requiring home enteral tube feeding. It outlines the medical and feeding history, details of the dietetic assessment and how blended diet has worked for this individual. This highlights some considerations for dietetic practice.

Consent has been obtained from the patient’s mother for this article.

K is a 2-year-old girl with a history of hypotonia, developmental delay and faltering growth. She was referred to the dietetic service and was first seen aged 8 months for faltering growth, evidenced by a drop of >2 centiles on her growth chart.

Despite food fortification and the introduction of oral nutritional supplements, her weight gain remained small and she had a nasogastric tube (NGT) placed aged 14 months to supplement her oral intake with commercial formula. After a period of 9 months (aged 23 months), she had a percutaneous endoscopic gastrostomy (PEG) placed given that she was expected to require enteral tube feeding in the longer term.

This case study demonstrates similar effects of blended diet on physical symptoms as described in the literature. Batsis et al. showed that blended diet improved gastrointestinal (GI) symptoms in 95% of participants within 3 weeks of starting blended diet. These findings are in line with research by Hron et al. who reported a reduction in gagging, retching and diarrhoea following the initiation of blended diet. Similarly, a review by Breaks et al. reported that a number of studies have demonstrated a positive effect of blended diet on symptoms of reflux and constipation. As well as objective changes in occurrence of GI symptoms, more subjective reports of improved health and wellbeing are evident in the literature. Some parents commented on their child’s “beautiful skin, shiny hair” whilst others explained that their child “just seemed healthier”. Children starting on blended diet have been reported to look “brighter” and have “more energy”.

In addition to the changes in physical symptoms, parents referred to being able to cook for their daughter which is particularly important to them. There are several studies which have drawn conclusions on the social implications of blended diet; several studies have acknowledged inclusion at mealtimes and the value of this for the child as well as the wider family. A review by Coad et al. refers to the “feeding relationship” valued by families and the role of blended diet in allowing families to nurture their children with food that they would otherwise have given orally. In addition, people also value freedom of choice regarding specific foods; several studies refer to the selection of ‘natural’ or ‘real’ foods in preference to commercial formula; Weeks et al. recognise a “cultural shift towards unprocessed foods” which is associated with families’ choice to use blended diet.

With Regards,
Joseph Kent
Journal Manager
Journal of Clinical Nutrition & Dietetics