G44(P) Use of liquidised food through gastrostomy

Abstract

Objectivesand Study Children with complex needs who are gastrostomy fed are invariably prescribed commercially produced feeding diets to meet their nutritional requirements. Popularity of a blended diet in the UK is rapidly increasing with a call for better recognition.1 Current published evidence is limited and hence no support from professional bodie. It is generally believed that blended diet through gastrostomy could have the potential risks of compromising nutritional stability, possible contamination and infection, and blockage of the tube.2,3 On the other hand blended diet is also reported to have nutritional, social and economic benefits.2,4 We would like to share one of our patient’s experience using blended diet through his gastrostomy. We believe by sharing this experience we will add to the evidence base for this evolving dietary practice.MethodsOur patient is a four year old boy who has a background history of hypoxic insult at birth resulting in the need for gastrostomy and fundoplication. We prospectively assessd his nutritional intake in the blended form.we performed accurate nutritional assessment and measured adequacy by blood tests.ResultsOur patient tolerated the blended with improvement ingrowth velocit and reief from reflux symptoms. Only dietiary deficiency exhibited was borderline zinc deficiency which was corrected by additional supplementation.ConclusionIt is our experience that blended diet given via a gastrostomy provided to this child with appropriate dietician supervision was beneficial. We did not notice any gastrostomy tube blockage or gut related infections. It enabled family to feel more satisfied with their ability to provide their child what they felt was a “normal diet.” We believe that more research is required to fully understand the benefits and risks associated with these diets.References Novak P et al. The use of blenderized tube feedings. Infant Child Adolesc Nutr. 2009;1:21–23Evans et al. Accuracy of home enteral feed preparation for children with inherited metabolic disorders. The British Dietetic Association Ltd. 2011 J Hum Nutr Diet. 2010;24:68–73Pentuik S et al. Pureed by gastrostomy tube diet improves gagging and retching in children with fundoplication. JPEN J Parenter Enteral Nutr. 2011;35:375

Patient and carer experience of blended diet via gastrostomy: a qualitative study

“…Participants also valued the social inclusivity of having a family meal consisting of ‘normal’ foods and the ability to have control over food choices with some choosing to include or exclude specific foods for therapeutic effect. Opinions held by participants in this research are in line with other case‐based reviews with regards to parents benefitting from using family foods which, in turn, normalises feeding . Study participants all described the basis of their meals being family foods rather than adhering to specific recipes via the gastrostomy.…”

“… also do not detail food preparation and storage practices, which can affect bacterial content of samples. Thiagesh and Hill also noted the absence of any complications including tube blockage, gastrointestinal infection or significant nutritional deficiencies. It is unclear whether there are risks associated with blended diet in the present study or if risks have been successfully mitigated, given that all participants will have completed a risk assessment as per local policy .…”

Blended diets for gastrostomy fed children and young people: a scoping review

“…Studies in the scoping review discuss the clinical impact and well-being of patients using a blended diet (6,40,51) , such as the intimacy of the feeding act between a child and parent, and the importance of providing a tube-fed child with the same meal as others in the family (38) . They also explain how using blended food ensures that children who are able to have some oral intake can receive the same food by mouth as they would by gastrostomy.…”

“…Perceptions and reality did not always match. One study reported that, in practice, dietitians found there were (20) Evaluate different enteral formulas Careful evaluation of formulas required in conjunction with available scientific and research studies prior to routine use in clinical practice Guenter and Lyman (2016) (33) To examine benefits and challenges for Enfit â Need open dialogue between manufacturers, clinicians and patients for success Thiyagesh and Hill (2016) (51) Single case study to describe impact of BD Improved tolerance and reduction in reflux and increase weight gain Thomas (2016) (34) To develop a protocol around administering BD in schools…”

A laboratory‐based evaluation of tube blocking and microbial risks associated with one blended enteral feed recipe

“…However, there is increasing patient and carer‐led interest in providing nutrition using blended or liquidised food that is prepared and administered at home . Reported benefits associated with blended diets include improvements in reflux and bowel problems and empowering patients and carers without ‘medicalising’ feeding . A number of concerns about the health risks associated with blended diets have been described and these include nutritional inadequacy, blocked feeding tubes and food‐borne infection .…”