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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel speaks with Lydia Collins Hussey, a specialist paediatric dietitian, about complementary feeding, weaning and allergen introduction for infants with food allergies.

The conversation delves into recent trends in food allergies, highlighting the need to translate research into clinical practice and policy. Lydia mentions the importance of maternal diets, the microbiome, and early allergen introduction. Cows’ milk allergy is identified as the most common, followed by egg and peanut allergies. Lydia outlines the process of managing a child with suspected allergies, including taking a detailed allergy-focused history, assessing symptoms (immediate vs. delayed), and considering family history and eczema.

The podcast then answers the question ‘What is complementary feeding’ and Lydia provides guidance around commencing weaning. This includes the numerous considerations that should be made regarding the safe commencement of weaning as well as the significance of food allergy management and early allergen introduction. 

For children with food allergies, Lydia advises starting allergen introduction between four and six months, especially for those with severe eczema or pre-existing allergies. She recommends introducing allergens in small amounts, mixing them with breast milk or formula, and ensuring the child is well during introduction. She also highlights the importance of maintaining tolerance by regularly including allergens in the diet.

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Ibrahim Amin, a lead practice pharmacist, about his experience managing cow’s milk protein allergy (CMPA). Ibrahim shares his journey into pharmacy, driven by a love for chemistry and a desire for patient contact.

The conversation explores the pharmacist's role in cow’s milk protein allergy (CMA) management, emphasising that it extends beyond dispensing prescriptions. Ibrahim discusses supporting patients and healthcare professionals, conducting audits, and ensuring adherence to guidelines. He highlights the importance of recognising that pharmacists are medicine experts and can provide valuable advice.

Ibrahim notes a concerning trend of delayed diagnoses and inappropriate management of CMA, often stemming from initial visits to A&E. He stresses the need for accurate diagnoses, appropriate formula prescriptions, and ongoing monitoring of patients. He discusses some of the common symptoms of cow’s milk allergy such as rashes and gastrointestinal symptoms.

The discussion delves into the importance of communication and collaboration within a multidisciplinary team. Ibrahim emphasises the value of virtual MDT meetings, which improve efficiency and accessibility.

Ibrahim shares practical tips for managing CMA, including reminding parents that "breast is best" and providing guidance on dairy-free diets for mothers who are breastfeeding. 

Dysphagia Chef Gary Brailsford and Independent Dietitian Caroline Hill sit down to discuss texture modified diets. From myth busting to best practice, they explore how to texture modified diets right, for your dysphagia patients.
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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Carol Baguley, a paediatric dietitian, about managing blended diets in a school setting. Carol shares her journey from South Africa to becoming a specialist in paediatric nutrition in the UK.

Carol's current role involves providing optimal nutrition to children with neuro disabilities at a specialist school. She manages a caseload of around 80 children, many of whom are home enteral feeding (HEF) dependent, with a significant portion also consuming blended diets.

The conversation highlights the practicalities of managing blended diets in schools, including food preparation, storage, and hygiene. Carol emphasises the importance of a blended diet policy, which is followed meticulously. Staff training is crucial, with school nurses playing a key role in educating carers and parents.

The discussion touches on the importance of individualising blended diets and considering factors like texture and nutrient content. Carol also mentions the use of fortified foods and specialised plant-based alternatives creams to enhance nutritional value. Consideration is also given to the care of feeding tubes for those individuals receiving a blended diet.

Carol encourages listeners to consult the British Dietetic Association (BDA) and the Food Standards Agency (FSA) for further information. She concludes by emphasising the positive impact of blended diets on children's well-being and the importance of a collaborative approach to care.

Dr Rosan Meyer, a Paediatric Dietitian, discusses the Cow’s Milk related Symptom Score (CoMiSS) and how it can help healthcare professionals to be more aware of symptoms related to Cow’s Milk Allergy (CMA) and support the diagnosis of CMA. You can access the CoMiSS tool here.

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Information for Healthcare Professional Use Only

In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel speaks with Mikayla Profe-Fuchsloch, a dietitian and assistant professor at the University of Coventry, about the impact of fibre inclusion in enteral nutrition for paediatric patients.

Fibre, which is classified by solubility, viscosity, and fermentability, increases stool weight, improves bowel regularity, and can balance stool frequency in both diarrhoea and constipation cases. All these features make it a useful addition to enteral nutrition.

It is not uncommon when managing paediatric patients with complex medical needs to have issues related with the gastrointestinal system.  There can be issues with gut dysmotility and symptoms such as gastroesophageal reflux, delayed gastric emptying, diarrhoea and constipation.

In clinical practice, adding in a fibre supplement or choosing a fibre containing enteral feed can help to manage these issues. Current guidance from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition on how much fibre per day paediatric patients require recommends an increased fibre intake in children with neurodisabilities of 17-21g of fibre per day.¹ This may be provided by the fibre from an enteral feed as well as the addition of a fibre supplement.  Fibre supplements that are partially hydrolysed, such as Partially Hydrolysed Guar Gum (PHGG), which can help to improve bowel motions1. PHGG has been shown to work as a prebiotic, supporting the growth of beneficial gut bacteria^2,3,4.

In addition, the combination of peptide-based feeds and fibre can help to improve tolerance and gastrointestinal symptoms. 

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Simon Williams, chief executive of Anaphylaxis UK, to discuss the organisation's role in supporting individuals and families affected by serious allergies.

The conversation emphasises Anaphylaxis UK's comprehensive support system, encompassing information, training, and a helpline. The organisation aims to improve every aspect of life for those with allergies, from school and work to dining out. Simon stresses the importance of creating a welcoming environment for individuals with allergies, particularly in the food industry.

The podcast addresses the rising prevalence of allergies, especially among children such as peanut allergy and cows’ milk allergy, and the need for increased awareness and procedures in schools. While the exact cause of this increase remains unclear, Anaphylaxis UK focuses on providing resources and training to ensure the safety of those living with allergies and at risk of anaphylaxis.

Simon highlights the organisation's extensive online resources, including fact sheets reviewed by clinical experts and lay members. Anaphylaxis UK is also developing video and audio support for these resources to enhance accessibility. The organisation actively engages with the public through social media and a newsletter, providing updates on research, innovations, and product allergy alerts.

Once the decision has been made to start a child on a blended diet, it’s never the dietitian alone who is responsible for supporting this. The entire multi-disciplinary team needs to be aligned and working closely together to help support this patient. Harriet Farr talks us through the role of the MDT in supporting blended diets and how this is best structured, communicated and monitored.

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In this podcast Lisa Philips-German, a Paediatric Nurse Consultant talks us through her unique role and how she successfully manages cows’ milk allergy patients in her paediatric community. Lisa will share the success of her clinic and how they have managed to empower and support parents and carers, work with other healthcare professionals and strengthen service provision in the community.
Important notice: Mothers should be encouraged to continue breastfeeding even when their infants have cows' milk protein allergy. This usually requires qualified dietary counselling to completely exclude all sources of cows' milk protein from the mothers’ diet.

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In this podcast Annina Whipp walks us through her experiences as a paediatric and freelance dietitian. What excites her about her role, her interests and the types of projects she gets involved in. Disclaimer: BDA endorsement applies only to the educational content of the learning activity.

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Information for Healthcare Professional Use Only

In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Marie Watson, a paediatric specialist dietitian, about her experience managing enteral nutrition patients in the community. Marie shares her journey into dietetics and her passion for working with children.

Marie shares her knowledge about peptide feeds compared to whole protein enteral feeds and the clinical benefits of these types of feeds.  Peptide feeds are commenced in response to poor tolerance to whole protein enteral feeds.

Marie outlines the process of transitioning patients to peptide feeds, emphasising a slow, gradual approach to monitor for adverse effects such as worsening tolerance/gastrointestinal symptoms. She notes that while most patients experience improved symptoms, it is crucial to be prepared to revert to whole protein feeds if necessary.

The discussion explores the use of low-calorie peptide feeds for patients prone to excessive weight gain, highlighting the importance of achieving adequate protein and micronutrient intake while managing calorie levels, helping to overcome the challenges of balancing feed volume and tolerance with meeting nutritional needs. Examples of the use of peptide feeds in clinical practice are also discussed.

Marie stresses the significance of a multidisciplinary team approach, involving gastroenterology consultants and tube feeding nurses, to provide comprehensive care for enteral nutrition patients.

In this podcast Timira Naicker walks us through her journey as a dietitian and how she made the transition into the field of regulatory. Timira gives us great insights about her regulatory dietitian role, what are her interests, what does a typical day looks like and how you can think about a career in regulatory. Disclaimer: BDA endorsement applies only to the educational content of the learning activity.

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