Blended diets for tube-fed children and young people: a rapid review update

Abstract

BackgroundMany children and young people with complex health and care needs use enteral feeding tubes to optimise their nutritional intake in the UK and other countries. Blended diets as an alternative to the exclusive use of commercial formula are becoming more commonly used, and there is evidence to support the benefits of using a blended diet on the child or young person and their wider family.A rapid review was published in 2017 exploring blended diets as a valid alternative to commercial formula for enteral feeding for children and young people. An update was necessary to ensure that professional practice is informed by the latest evidence, which has expanded significantly since the publication of the original article.MethodsA rapid review method was used and the PRISMA checklist formed the basis of the protocol devised ahead of data collection. Key databases included: PubMed, MEDLINE, CINAHL, PsychINFO, Google Scholar.Results29 articles were included and four themes were identified from the collated data. (1) Symptom improvement and clinical outcomes, (2) nutritional content, (3) caregiver experiences and (4) blended diet practices. Findings showed that blended diets can have a positive impact on physical symptoms as well as social influences extending to families and carers.ConclusionNutritional content, food hygiene and viscosity of food blends are important considerations for professionals and families to ensure safe practice when using blended diets for enteral feeding.

An exploration of the experiences and attitudes of healthcare professionals towards enteral tube feeding for adults living in the community following stroke

“…24 Interest in the use and potential benefits and management of risk associated with blended feeding has grown in the last 10 years and is no longer formally opposed. 25 Many blended feeding studies focus on its delivery to children and young adults 26,27 and, although adult studies have been undertaken, these have mostly investigated commercially-or hospital-prepared blended feeds rather than feeds made at home. 28 No studies of blended feeds have been identified in community-based adults following stroke.…”

“…Although the potential risks associated with blended feeding cannot be ignored, evaluation of their extent in published literature does not provide evidence that indicates that blended feeding is extremely risky and should be avoided but considers how risks can be mitigated. 10,25 The strengths of the present study include the collation of experience from a range of healthcare professionals, predominantly dietitians, who work with adults following stroke who are receiving tube-feeding in the community, and their collective expertise has been drawn from many years of practice. The questionnaire was designed with both open and closed questions to enable quantitative analysis of some key responses and qualitative exploration of free-text responses to gain a rich understanding.…”

“…14 Three main themes emerged from responses about how participants manage the safety risks they had identified. The first focussed on revising their patient's feeding regime to address tolerance issues and this included changing the type of feed, for example, modifying fibre content (25), changing the feed delivery rate, for example, reduce rate of feeding, more concentrated feed (10), or changing the feed delivery method, and, for example, trialling bolus feeding with close monitoring depending on the indication for the pump in the first place (68). The second theme addressed safety issues through communication with patients, their family and a wide range of professionals, for example, get the appropriate [multidisciplinary team] members involved, i.e.…”

Better understanding of use of blended diets and its benefits

“…The review update by Phillips and Coad 6 gives the latest evidence on the use and effects of blended diets in the last 5 years since their review was published in 2017. 7 The authors appropriately used Cochrane rapid review for the condition of this review update including 29 papers.…”

Call for sustainable food systems including (medical) nutrition for hospitalised children and their families

“…These diets involve creating uniform mixtures from whole foods or minimally processed ingredients for individuals with complex medical conditions. 80 Blended diets may provide psychological and social benefits for parents by using real food over commercial formulas. However, concerns linger about potential blockages, nutrition suitability and adequacy as well as financial considerations for individual families.…”