Blended Diet or ‘BD’ for short has been around for a while and has generally been a parent-led movement with parents looking to feed their tube-fed children real food like any other child eating orally. It has been steadily gaining popularity among the BD community with adults and children alike and healthcare professionals are now acknowledging the need to be able to support this.
What tools and guidelines for BD do we now have in the Healthcare setting?
The Use of Blended Diet with Enteral Feeding Tubes. British Dietetic Association 3 Practice Toolkit (2021) (1)
The Use of Blended Diets in Children With Enteral Feeding Tubes: A Joint Position Paper of the ESPGHAN Committees of Allied Health Professionals and Nutrition (2022) (2)
The publication of these toolkits was a huge step forwards in a) acknowledging the use and benefits of BD in enteral tube feeding and b) providing Dietitians and other healthcare professionals with a practical guide to support families in starting BD. Both recognise the need for more research in this area to ensure confidence in this feeding choice especially in more vulnerable populations with more complex needs.
This blog will explore the health benefits of starting a blended diet for children with Gastrostomy tubes and why more families and healthcare providers are considering this approach.
What is a Blended Diet?
A blended diet is made by blending regular whole foods such as fruits, vegetables, grains, proteins, dairy/plant alternatives and healthy fats into a smooth consistency that can be administered through an enteral feeding device - traditionally this is a gastrostomy tube of minimum size 12 Fr with a consistency no thicker than an IDDSI level 3 (liquidised food or a moderately thick drink) to avoid tube blockages (3).Meals can be tailored to meet the individual nutritional needs and preferences of the child/family, offering flexibility and variety.
BD can be used in the following ways:
1. As a sole source of nutrition for orally fed children on a texture-modified diet
2. As a top up via tube for those who can eat orally but not enough to sustain them
3. As a sole source of nutrition for those children who need all their nutrition via tube
4. As partial nutrition for those who mix and match between BD and Commercial feeds/formulas.
When is a Blended Diet Not Suitable?
While a blended diet offers many benefits, it’s not the right fit for every child. Some children may have medical conditions requiring specialised formulas or have a feeding regimen incompatible with whole foods, or be unable to be fed into their stomach (we currently do not advocate feeding BD into the small bowel). Always seek guidance from your child’s healthcare team before making changes to their diet.
Health Benefits of a Blended Diet
1. Nutritional Quality
Whole foods offer natural vitamins, minerals, antioxidants, and fibre that are often missing or less bioavailable in commercial formulas. A blended diet allows parents to provide a balanced mix of nutrients that support their child’s growth, development, and immune function.
Example: Adding salmon provides a good source of omega 3 fats and protein while sweet potatoes contribute beta-carotene and fibre.
2. Reduced Gastrointestinal Issues
Many parents and caregivers report that children experience fewer gastrointestinal problems, such as gagging, reflux, constipation, or diarrhoea, when transitioning to a blended diet. This may be due to the inclusion of fibre, which supports healthy digestion and the increased viscosity (thickness) of the feed.
3. Greater Tolerance and Variety
Children with allergies, sensitivities, or intolerances to certain ingredients in commercial formulas may benefit from a customised blended diet. This approach allows parents to avoid problematic foods and introduce a variety of flavors and textures, potentially enhancing tolerance and minimising food-related issues.
4. Being Involved In Family Mealtimes
A blended diet can foster a stronger connection to food and eating for both the child and their family and allows the child to feel included at family meal times and occasions. The act of preparing meals using fresh ingredients encourages families to think holistically about nutrition and offers a sense of normalcy.
5. Potential Cost Savings & Sustainability Benefits
More research needs to be done in this area, but anecdotally, some prescribed medications for example for reflux or constipation can be reduced or stopped over time with the improvement in Gastrointestinal symptoms on BD. This ultimately is a cost-saving for the NHS not only in medication expenses but also in equipment such as syringes. Reducing reliance on commercial formula/feeds will also reduce plastic waste despite the newer manufacturing allowing recycling of these plastics. It will be interesting to see sustainability studies comparing feeding BD including the plastic syringes and storage equipment against using commercial feed/formula and onward recommendations.
6. Improved Quality of Life
Parents and caregivers often observe improvements in their child’s wellbeing, energy levels, and sleep patterns when switching to a blended diet. A well-nourished child is more likely to thrive and enjoy daily activities.
Conclusion
A blended diet for children with Gastrostomy tubes can be a nutritious, cost-effective, and highly personalised alternative to commercial formulas. It offers the benefits of whole-food nutrition, supports gastrointestinal health, and enhances the overall quality of life for both the child and their family. If you’re considering a blended diet, consult with your healthcare provider and take the first steps toward this nourishing journey.
I think this could be for me but what next?
Look out for a series of blogs that cover how to get started, how to discuss with your dietitian, practical considerations, recipes, nutritional considerations and much more….
At #OxfordPaediatricDietitians we can support you at any stage of your journey, whether you are contemplating starting a blended diet and need to talk this through in more detail or an established tubie needing support to troubleshoot or check nutritional adequacy. Click here to learn more: Services | Oxford Paediatric Di
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