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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.

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In this episode of the Inside Medical Nutrition Podcast, Dr. Linia Patel interviews Catherine Fogarty, a paediatric dietitian, about managing a tube-fed blended diet caseload. Cath shares her journey from being a chef to a dietitian, highlighting her passion for food and nutrition. She currently manages a caseload of 100 tube-fed children, with approximately 15% on blended diets.

Cath discusses the evolution of blended diet acceptance, noting the positive impact of the British Dietetic Association's policy statement in 2019. She emphasises the importance of a collaborative approach with parents, involving them in the decision-making process and providing education on food safety, preparation, and nutritional adequacy.

She outlines the challenges of managing a blended diet caseload, particularly with children who have neurological impairments or food aversions. Cath emphasises the need for a holistic approach, considering factors beyond the feed itself, such as the gut-brain axis and the child's social environment.

Cath shares strategies for managing her time, including prioritising urgent cases, utilising virtual consultations, and seeking support from colleagues and professional organisations like DISC (Dietitians Interested in Special Children). She stresses the importance of starting slowly with blended diets, treating it like weaning, and empowering parents to make informed choices.

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel hosts a discussion with Sandra Robinson, a speech and language therapist, and Caroline Hill, a dietitian, about the importance of a multidisciplinary team (MDT) approach in managing patients with dysphagia.

The discussion begins by defining the different types of teamwork: multidisciplinary, interdisciplinary, and transdisciplinary. The guests emphasise the value of an interdisciplinary approach (IDT), where team members actively collaborate and communicate to provide coordinated care. They contrast this with a multidisciplinary approach, where professionals work independently with less interaction.

The podcast highlights the diverse members of an MDT, including physicians, nurses, therapists, assistants, chefs, and, importantly, the patients and their families. They discuss how MDTs function in primary care and the role of specialist nurses in bridging communication gaps.

The conversation explores the impact of COVID-19 on dysphagia management, particularly the increased reliance on telehealth. While telehealth offers benefits, it also presents challenges, such as ensuring patient safety, relying on facilitators, and addressing communication barriers. Best practices for virtual consultations include being prepared with technology, supporting patients and facilitators, and setting clear expectations.

The guests stress the importance of ongoing education and awareness of dysphagia, suggesting that speech and language therapy training should begin at the undergraduate level. They also propose considering a title like "dysphagia practitioner" to better reflect the scope of practice.

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.
IDDSI Framework

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews dietitians Jamie Leung and Sam Ogundere about blended diets in transitional care. Jamie and Sam discuss their roles supporting patients needing enteral feeding, as they observe  an increasing number of adults requiring blended diets. They highlight the variety of conditions necessitating enteral feeding tubes, including stroke, MND, Parkinson's, and cancer.

The conversation explores the use of homemade blended diets, with Jamie estimating that around 5% of their paediatric caseload relies entirely on blended diets, while 30% use them partially. They share positive experiences regarding tolerance and the natural inclination of parents to blend familiar foods. Challenges include inconsistent support from schools and the resource demands of administering blended diets.

The discussion shifts to tube feeds with food-derived ingredients, which both dietitians embrace as a valuable option, particularly for parents with limited time, small kitchens, or financial constraints. They acknowledge that awareness of these options is still growing, and that initial management often focuses on medical solutions.

Jamie and Sam emphasise the importance of open-mindedness, flexibility, and parental involvement in blended diet management. They recommend the EPSGHAN guideline for children and the BDA toolkit as helpful resources. The need for risk assessment forms, information leaflets, and nutritional analysis programs is also highlighted.

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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Managing the nutrition and hydration needs of dysphagia patients in the care home setting can be challenging. Sophie Murray Quality Improvement and Regulatory Partner for Signature Care Homes sits down with Linia to discuss optimal management and the positive impact this can have on patient outcomes.

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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 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 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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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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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.