One of the many challenges patients on blended diet face is feeding in hospital. Many hospital Trusts do not have a blended diet policy in place to enable easy access to blended food for tube feeding purposes. However, certainly in Paediatrics this is improving and many specialist Children's hospitals are now more on board with this and provide options to support with feeding a blended diet (ranging from blended diet menus, providing ambient food pouches to allowing blended food to be brought in from home or accomodation settings).
What are the barriers to feeding blended diet in hospital?
Food safety Traceability of food - any food brought in from outside may increase the risk of foodborne illness if food hygeine standards have not been followed. If food poisoning occurs this may make the patient very poorly and delay recovery. If a combination of using food from catering and food from outside sources, it would be difficult to pinpoint the source of the infection and pose worrying concerns for the Catering department.
Meeting nutritional requirements There may be occassions whereby the nature of being in hospital changes the individual's nutritional requirements; they may need more energy and protein for healing and recovery; they may have had some upset to their digestive tract needing lower fibre for a period, or benefit from additional supplementation of vitamins and minerals. It is therefore useful to be able to speak to the hospital dietitian to discuss this in more detail.
Tolerance Occassionally feeding tolerance is affected by being unwell and what is usually well tolerated for some reason is not. What and how you feed may change for that period and may require a deviation from 'normal'. This can be in what you feed (contents of the blends), frequency - more little and often, or route of nutrition (period of jejunal feeding if the stomach is too slow to empty for example). It may be recommended that blended diet be put on hold during the admission or only given in very small amounts and that nutritional needs met by a commercial feed for the period in hospital.
Clinical setting Some clinical areas such as intensive care, high dependency or oncology wards may have strict feeding protocols and not allow blended diet whereas other wards may be more amenable. It is important to agree an alternative feeding plan in this instance.
Who can give the blends The majority of the time the parent or caregiver is involved in feeding blended diet, however in the event they are delayed or absent for an unplanned reason (e.g. unwell at home) this can pose an issue. It is therefore important that on admission this scenario is planned for with a mutually agreed plan to minimise any feeding-related stresses! A sensible solution would be to agree what feed is acceptable to use for when blended diet cannot be given. Details of the feed name, volume and rate should be clearly documented to reduce the change of other feeds being given that perhaps are less tolerated. If the feed is a powdered feed needing constituiting in a specialist feed unit it is essential that the correct procedues are followed.
My child is coming in for a planned admission - how can I be more prepared?
Pre-op assessments Often feeding is not included in pre-op assessments however this is a vital opportunity to discuss how your child will be fed during the admission with your surgeon or Dr. For instance, will they need to be fasted before a procedure? how long afterwards will they need to remain nil by tube/mouth?, can they go on to have their usual home feeding plan or does this need to be adjusted?
Call the dietetic department It can be useful to call ahead to the dietetic department to see what the policy is on blended diet, you may be given useful information on what is available on site and if blends are allowed to be brought in from home, or if it would be useful to purchase some ambient food pouches to feed in hospital (e.g. Wilbos or Food Untethered for example).
During the stay Find out if there are any available food items that could be useful; for example readybrek or weetabix on the ward or anything IDDSI-friendly from hospital menu (e.g. smooth yoghurt or custard). Can the wards order any extra milk or dairy-free milks like soya or oat milk to support blends? Some hospitals will allow you to order from the pureed menu (IDDSI 4) and think down to IDDSI level 3 at ward level providing you feed this in a given time.
What have I learnt from parents feeding blended diet?
As a Children's dietitian working both in an NHS and Freelance capacity it is important that I accept "I do not know it all" and there is learning to be had from parents. Here are some powerful testiments that have made an impact on me:
"Why feed my child a commercial feed that will make their reflux and vomiting worse, they will just vomit into their breathing mask & potentially aspirate & we will then have further delays in their recovery"
"If my child was orally feeding a pureed diet they could pick from the menu, what's different about the fact that they need to use their tube to eat?"
" Many things in hospital are out of our control, feeding is one thing I can help with as a parent, it makes me feel that i'm making a difference"
" If I have to feed commercial feed in hospital this will impact on tolerance levels and we will have more nutrition lost from vomiting or diarrhoea which defeats the object of staying nourished to get better"
Final thoughts
Blended diet is becoming more recognised as a feeding choice by hospital settings but it will take time until this is more commonplace. In the meantime, to minimise feeding-related stresses, planning ahead, and finding out what options are available will help parents and caregivers be prepared and reduce any delays in feeding.
It would be helpful for there to be an agreed alternative to blends should this scenario crop up, and if this is a very specialist feed, for parents to have an unopened tin to be brought to the ward in case the hospital does not keep it in stock.
Due to the rising increase of patients on blended diet, and young people transitioning to adult services, hospitals who do not have a blended diet policy should be encouraged to reach out to Trusts who do to see if this could be adopted in their setting.
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