Blended feeds in children and young people
Aspects of blended feeds in children and young people are explored through the following three studies.
Enteral feeding has significantly increased over past 30 years but the use of blended ‘real’ food is gaining increasing public interest. Enteral feeding in children and young people (CYP) unable to tolerate an oral diet or maintain an adequate body weight is used to promote growth, health and well-being. It is mainly used in CYP with neurological dysphagia and complex healthcare needs, gastrointestinal disorders or life limiting conditions.
In the UK only commercially prepared enteral feeds, fluid and liquid medications are recommended for administration through any enteral feeding device. Debate among professionals has prompted the release of several policy/position statements and guidance recommendations. Aspects of these issues are explored through the following three studies.
- Blended diets may have potential medical and emotional benefits.
- A blended feed is described as everyday food and fluids blended to a consistency of stage one baby food (smooth single cream).
- Blended feeding is an evolving area of practice for enterally fed patients of all ages.
- As blended feeding increases, nurses must expand their knowledge to ensure appropriate care.
Blended foods for tube-fed children: a safe and realistic option? A rapid review of the evidence
A literature review using systematic principles, strict inclusion and exclusion criteria, data extraction and critical appraisal techniques found 18 studies.
From these a number of themes were identified and collapsed into three key categories. These were linked to safety and efficacy, potential benefits in specific clinical circumstances and cautious optimism if more robust, higher level evidence were to become available.
Despite a paucity of high level evidence, the authors conclude current knowledge about the risks, limitations and benefits of blended enteral feeds can be used to inform discussions, empower parents and families, guide future policy and practice and promote more robust research studies that explore outcomes and family experiences of blended food for gastrostomy tube feeding.
Coad J, Toft A, Lapwood S et al (2017) Archives of Diseases in Childhood. 102, 3, 274-278
Multi-agency practice for developing a blended diet for children fed via a gastrostomy
Under this service improvement case study, one health board in Wales took a multi-agency partnership approach that included parental participation. The aim was to investigate and facilitate a parental request that their child receive blended enteral feeds in preference to using a prescribed commercial formula when the child started school.
Following critical evaluation of current evidence and issues such as the health board’s accountability, a protocol and governance framework was collaboratively developed to inform the implementation of safe, effective best practices. In partnership with the multiple agencies, a bespoke care plan was created and delivered.
Positive outcomes were reported from the child, family, school and health professional teams. Blended feeding is an evolving area of practice and this initiative should have wider implications for enterally fed patients of all ages in the future.
Thomas S (2017) Nursing Children and Young People. 29, 6, 22-25.
Use of blenderized tube feeding in adult and pediatric home enteral nutrition patients
This cross sectional, online survey was conducted in United States between a health and education facility and members of a national not for profit organisation providing education, advocacy and networking support to people dependent on home parenteral and enteral tube feeding.
Of 216 survey participants, 125 were children or young people (CYP) under 18 years of age, and 112 used blenderized tube feeds (BTF) for an average 71% of their daily nutritional intake. Of these, 84 CYP used self-prepared, homemade blends with a minority using a combination of homemade and commercial feeds. Only one young person used a commercially manufactured feed only. BTF was highly prevalent in this study and higher than in previously reported data. To mitigate against potential negative clinical outcomes in growth and development further training, education, support and ongoing monitoring in addition to access to appropriate practical resources will need to be created.
Epp L, Lammert L, Vallumsetla N et al (2017) Nutrition in Clinical Practice. 32, 2, 201-205.
Kathy Davis is a nurse researcher at the Children’s Trust in Tadworth, Surrey and an independent specialist nurse consultant, colorectal and pelvic floor disorders in Wimbledon, London.