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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 Smruthi Venkat, a speech and language therapist (SLT) specialising in stroke rehabilitation. They delve into the complexities of dysphagia, swallowing difficulties commonly experienced by stroke patients.

Smruthi explains that stroke patients present with varying swallowing impairments depending on the location of the stroke. These can include oral motor weakness, sensory deficits affecting the ability to distinguish food temperatures or detect residue, and impaired coordination of the four-stage swallowing process.

The conversation highlights the importance of early swallow screening for stroke patients upon hospital admission. If difficulties are detected, a specialist assessment by a speech and language therapist is crucial. This bedside swallowing assessment involves a detailed case history, cranial nerve and oral motor examination, and observation of the patient consuming different food and fluid textures.

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 Dr Graeme O’Connor discusses his role as a research dietitian and how he made his first research move in the field of refeeding syndrome. After the success of developing clinical guidelines for the management of refeeding syndrome, Graeme went onto to research tube feeding formula containing food derived ingredients at Great Ormond Street Hospital. Graeme also highlights how dietitians can work with industry to test important questions such as 'how can a blended diet work in a hospital setting?'  Disclaimer: BDA endorsement applies only to the educational content of the learning activity.

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In this podcast Dr Michelle Harvie discuses the importance of research and setting research questions to test a hypothesis. One particular interesting area of work researched by Michelle is the very low-calorie diet and the 5:2 diet within diabetes. Disclaimer: BDA endorsement applies only to the educational content of the learning activity.

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In this podcast Dimitrios Koutoukidis discusses his journey as dietitian from Greece and now in the United Kingdom. His master’s degree enabled him to move into the field of research and is now working on some fantastic research that may support non-alcoholic fatty liver patients in the future. Disclaimer: BDA endorsement applies only to the educational content of the learning activity.

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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.

Information for Healthcare Professional Use Only

Information for healthcare professional use only

In this episode of the Inside Medical Nutrition Podcast, Dr. Linia Patel discusses the tolerance of blended diets with experts Lucy Jackman, a paediatric dietitian, and Dr. Graham O'Connor, a research lead for dietetics, both from Great Ormond Children's Hospital.

The conversation begins with the experts sharing their backgrounds and their journey into dietetics. The discussion then shifts to the increasing use of blended diets, which are household foods blended into a liquid form for tube feeding. Parents are increasingly drawn to blended diets due to a desire for natural food and the feeling of fulfilling their role as caregivers.

The experts address concerns about blended diets, including tube blockages, nutritional adequacy, and food hygiene. Research suggests that in practice, these concerns are not significantly different compared to commercial formulas. Key considerations for blended diets include using appropriate tube sizes, avoiding nasogastric (NG) tubes, ensuring proper consistency, and maintaining food safety standards.

The podcast explores the role of food-derived ingredient formulas as a middle ground between blended diets and commercial formulas. The speakers share their experience of using these formulas and how they can be particularly useful in hospital settings where providing fresh blenderised food is challenging. They also offer a way to control electrolytes and provide fibre, which is beneficial for gut health, both of which is particularly important in intensive care patients.

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.

Information for Healthcare Professional Use Only

Information for healthcare professional use only.

In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Professor David Wright and Jan Flynn about improving medication administration for people with dysphagia.

The conversation highlights the challenges faced by patients with dysphagia around swallowing medication, particularly tablets. Therefore, emphasising the importance of considering dysphagia when prescribing medications in dysphagia management. David stresses the need to first assess whether the medication is still necessary and effective. If so, alternative routes (e.g. patches) and formulations should be explored before resorting to crushing tablets. Both experts caution against routinely crushing tablets, as it can alter drug release, cause side effects, and increase the risk of medication errors. They highlight the complexities of liquid medications, including stability issues and the potential for interactions with thickeners used for dysphagia management.

Both experts share their own professional experience of supporting patients with dysphagia and the challenges they have faced with the medicine management in this patient group.  Examples of projects and addressing knowledge gaps in this area of dysphagia management are also shared.

The podcast concludes with a call for greater awareness and education among healthcare professionals regarding dysphagia and medication administration. They emphasise the need to prioritise patient safety and quality of life by carefully considering medication options and seeking expert advice when needed.

Listen to the full podcast episode to learn more about administering medication to patients with dysphagia.

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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.

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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.