Dieititian FAQs - Answered

What equipment do I need?  

 

  • 60ml syringes – for bolusing the blend & for water flushes afterwards 
  • If making blends in advance – something to store these in such as sterifeed bottles (come in different sizes from the dietitian), some parents use freezer bags/ breast milk storage bags if they do not have room in their fridge/freezer to store bottles.  
  • Extension sets – for gastrostomy buttons 
  • Blender –some people choose to start with fruit or vegetable pouches which are the right consistency for putting down the tube or make thin porridge using instant oats so are blender free initially. This is fine to start with if mixing and matching with feed or formula however would not constitute a nutritionally adequate diet alone so many people go on to purchase a more powerful blender which can blend whole meals to the right consistency. 
  • Basic blenders – great for blitzing easy to blend ingredients like soft fruits and cooked veggies. Some people like to sieve blends to ensure they remove any particles which pose a risk to blocking the tube (e.g. fruit pips).   

More powerful blenders (Blendtec, Vitamix) can blend any ingredients including nuts, seeds, meat e.t.c removing the need to sieve and allowing a more diverse range of foods to be blended with ease & make batch cooking a dream. 

 

Are there any grants available to help fund equipment?


Please check here for more information: 
Kitchen appliances - Family Fund 

Vitamix - reconditioned blenders 

Some Charitable funds may also support bids for equipment. 

 

My community team says I need to do a risk assessment to start BD – what is this/ how can I prepare for this? 

 

Many departments like to conduct a risk assessment to ensure families have thought of everything in advance as moving to feeding blended diet can be a change & require a but more thinking and organising. It is also a tool looking at risk: benefit to ensure it’s the right decision for everyone involved.  

Top tips for planning for the risk assessment include: 

  1. Motivation to feed Blended diet – are there tolerance issues with feed/formula? Do you want to feed your child the same foods as the rest of the family for inclusivity?  

  1. Knowledge and understanding of nutritionally balanced diet and food safety. 

  1. Practically – how are you going to include blended diet into your routine? 

  1. Equipment – what will you need in advance/changes to the dietitian/nursing accounts for plastics/ancillaries 

  1. Will you use feed or formula in combination with blends? How does this impact your prescriptions? 

  1. Troubleshooting advice – what to do if your tube blocks/ who to contact. 

  1. Training – will anyone outside the home need training on blended diet (e.g. school/pre-school settings, respite centres) 

Monitoring – agreed timeframe for monitoring and review. 

 

Is Blended Diet right for me?

 

Blended diet is a commitment however, many parents and caregivers report a reduction in gastrointestinal symptoms such as vomiting or diarrhoea when feeding blended diet. Improved tolerance can also allow some children to receive larger volumes of blends in one sitting thus improving nutritional intake and supporting weight gain and growth. 

Anecdotally many say their child is better in themselves, less lethargic, more colour in their cheeks, sleep better e.t.c. – the ESPGHAN position statement contains more information the-use-of-blended-diets-in-children-with-enteral.pdf 

Check out this latest blog for more information The Blended Diet Movement 

 

How do I transition from feed/formula to BD?

 

This can be very individual depending on a number of factors and should be discussed with your dietitian and healthcare professionals first. 

General considerations are: 
1. Has your child ever eaten real food before (i.e. you know what they tolerate/any allergens identified) 
2. Are they volume sensitive – will they tolerate larger volumes of blends or would a little and often regimen be best initially? 
3. Will you still use some feed or formula in the day or night? 
4. Time – this may need to be done slowly a bit at a time to allow the gut to adapt. 
5. For some children it’s best to introduce blends in the home setting until established and keep feed your usual feed in educational or respite settings until you are confident your child tolerates blends well. You can then explore introducing blends here. 
 

 

Can I do combi feeding? Mix and match of feed and blends?

 

Absolutely! Many parents or caregivers use a combination of blends and feed or formula. Some use commercial feeds as the liquid to blend with as find this easier and more of a nutritional blanket.  

Some children will benefit from an evening or overnight feed still but just have blends in the daytime. 

Some children have blends at home but commercial feeds when out and about or at educational settings. 
 

What is the guidance on storing and reheating blends?

 

The BDA blended diet toolkit is a great starting point for information on safe preparation, handling, storing and reheating of blends Contents 
 
Food prep 
1. Clean hands, clean work surface when preparing food 
2. Ensure food is fresh & within use by dates  
3. Once blended food should be used within 2 hours or refrigerated/frozen. 
4. Clean all equipment in warm soapy water, rinse and leave to air dry. 

Storage of blended diet 
1. Ensure fridges are <5ºC 
2. Store in an airtight container situated above any raw foods to avoid cross contamination 
3. Use refrigerated blends within 24hrs. 
4. Blends can be frozen and used within 3 months (label with expiry date for ease) 
5. Frozen blends should be thoroughly defrosted in the fridge prior to use.  
6. Defrosted blends stored in the fridge should be discarded after 24-48 hours as with freshly prepared blends. 

Reheating of Previously Prepared Blends 
 
The content of the blends will dictate whether it should be reheated or not. Ingredients posing a low food poisoning risk such as fruit and cereals do not need reheating whereas blends containing meat, fish or chicken for example would. Rice & pasta also fall into this category due to the potential presence of Bacillus cereus sporoforms.  

Reheating blends stored in the fridge 

Blends containing meat, poultry or previously cooked foods:  
• Remove from the fridge, transfer to a suitable container (if not already in one) and microwave until ‘steaming hot’ or ‘piping hot’ throughout.  
If using a food thermometer reach a minimum of 70°C for at least two minutes.  
• Allow to cool before administering, until at a temperature that could be safely eaten orally.  

Blends not containing meat, poultry or previously cooked foods or a blend made from foods that could be eaten cold (e.g. sandwiches, yogurts, jarred baby food):  
• Option 1 – remove blend from the fridge and stand on a work surface for 30 minutes to allow this to come to room temperature.  
• Option 2 – remove blend from fridge and place the container in a jug of hot water for no more than 10 minutes. Shake or stir before administering. 

Reheating blends which are frozen and then defrosted 
The blend will need to be reheated. It needs to be heated through until it reaches 70°C for at least two minutes (a food thermometer may be useful), or the food needs to be ‘piping hot’ or ‘steaming hot throughout. 

 

How should I transport blends? 

 

Blends should be maintained at temperatures less than 5°C during transport until ready to be given (e.g. if stored at school or outside the home) 

Cool boxes with ice packs help keep the temperature cool during transportation. 

 

How do I know if my child is getting enough nutrition? 

 

Generally, your child will be gaining sufficient weight and height for their age and not be showing any signs of hunger or thirst.  

If they have had any nutritional bloods these will come back as normal. 

Generally, for children without specialist nutritional needs, portioning up a balanced meal of sensible portion size for their age and activity will provide enough nutrition. 

First steps nutrition and British Nutrition Foundation has some great resources for feeding children aged 1-5 years 
Eating well early years — First Steps Nutrition Trust 
Nutrition for toddlers and pre-schoolers 
 

Gov.uk has some guidance on portion sizes for older children 
Portion sizes and food groups - GOV.UK as does the Caroline walker trust Publications | The Caroline Walker Trust 

Disclaimer: speak to your dietitian if specific energy, protein or nutrient targets are needed as these may differ from child to child. 

 

How much extra water should I be giving to keep my child hydrated?

 

As a rule of thumb, professionals use this following calculation based on age and weight for a ballpark figure: 

0-10Kg 100ml/kg (so a 10kg child needs 1000ml fluid a day) 
10-20kg +50ml/kg (so a 15kg child needs 1000ml plus 50ml x 5kg = 1250ml a day) 
20kg + 20ml/kg (so a 30Kg child needs 1700ml a day) 

However, some children may be well hydrated on less fluid or will have additional losses so require more fluid so it is important to discuss this with your dietitian or healthcare professional. Remember that in hot weather children on tube feeds may need additional water flushes to stay hydrated just like someone who is eating and drinking orally. 

Fluids can include the liquid used in blends plus any additional water flushes. Some foods naturally contain fluid such as fruits or yoghurts for example so can also contribute towards hydration. The BDA blended diet toolkit recommends blends count as 70-75% fluids. 

As an example, a child weighing 15kg on the following regimen: 
3 x 200ml blends and 2 x 60ml snacks with 60ml post blend water flushes would have 540ml fluid as blends, 300ml fluid from flushes = 840ml. Fluid requirements = 1250ml meaning an additional 410ml fluid would be needed to meet their daily needs. This could be met by giving a 60ml water flush before blends and 2 x 60ml flushes with any medications or 110ml as a water ‘drink’ through the tube in the evening. 

See here for useful guidance: 
Fluid (water and drinks) and hydration - British Dietetic Association (BDA) 
 

Disclaimer: ensure hydration needs are discussed with your dietitian and you have a clear plan when feeding blended diet. 

 

My child is on a specialist feed – is it safe for me to try blended diet? 

 

For some children with complex needs blends are not always tolerated or the best feeding plan for their medical condition(s) so it is important this is discussed with your medical team and dietitian.  

Some specialist diets such as ketogenic diet can be given as blends (if appropriate) under the specialist guidance of a ketogenic dietitian. 

 

What if my child goes into hospital?

 

Accommodating blended diet in a hospital setting varies according to where you are going. Advance planning is useful so please discuss with your dietitian or healthcare professional and/or call up ahead of time to find out their policy if this is a planned admission. 

The following blog outlines more information: Blended diets - in hospital settings 
 

What else could my dietitian support me with?

 

Depending on the experience, time and resources your dietetic team have they could support with the following: 

  1. Have they a written ‘getting started’ guide they could share? 

  1. Checking the nutritional adequacy of the blends against your child’s individual needs (note these needs may change over time so you may wish to check at various points) 

  1. Ideas for meals and snacks 

  1. Troubleshooting advice 

  1. Supporting with writing statements of need (e.g. dietary needs for EHCP) or training in educational settings or travelling abroad. 

Please note that Oxford Paediatric Dietitians offer a variety of blended diet services including nutritional analysis which can be accessed here: Services | Oxford Paediatric Di 

 

I feel a little overwhelmed, what support is out there? 

 

The Blended diet facebook group is a very informative forum for both paediatric and adult blended diet. Blended Diet UK | Facebook 

This is a great website full of information & links 
Useful Links | blended-diet-online 
The BLENDS Project 

If you would like to speak to a dietitian who is separate from your local dietitian please do consider booking with us: 
Services | Oxford Paediatric Di 

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