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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Harriet Farr, a paediatric home enteral feeding dietitian, about navigating blended diets on a budget amidst the current cost of living crisis. Harriet shares her journey into dietetics and her passion for supporting children requiring tube feeding.

The conversation begins with a definition of what is a blended diet, emphasising the use of real food ingredients blended to a suitable consistency for administration via gastrostomy tubes. Harriet also mentions commercially made feeds with food-derived ingredients. She then delves into the practical aspects of supporting families on blended diets, including liaising with medical teams, providing information on benefits and potential problems, and ensuring safe preparation and administration.

A significant portion of the discussion focuses on the impact of the cost-of-living crisis on families using blended diets. Harriet acknowledges the financial strain and the reluctance of parents to discontinue blended diets due to the positive impact on their children's gastrointestinal symptoms. She emphasises the importance of dietitians being aware of these challenges and offering practical solutions.

Harriet provides several budget-friendly tips, such as utilising more affordable protein sources like beans and lentils, which also offer added fibre. She suggests considering frozen fruits and vegetables and batch cooking to reduce costs and time. Harriet also highlights the importance of menu planning, shopping lists, and buying in bulk.

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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.

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 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 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.

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 episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Claire Thornton-Wood, a paediatric dietitian, about Avoidant Restrictive Food Intake Disorder (ARFID). ARFID is a relatively new diagnosis, recognised in 2013, that encompasses various previous conditions like infantile anorexia and extreme selective eating. It is categorised as an eating disorder, however, unlike other eating disorders, ARFID is not related to body image concerns. Claire emphasises that ARFID is a mental health diagnosis with significant physical implications. It affects both children and adults, with a possible family link.

Claire explains that ARFID is characterised by a pattern of avoiding certain foods or food groups, restricting quantities, and not being influenced by body image. The United States Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria include persistent failure to meet nutritional needs, leading to weight loss, nutritional deficiencies, dependence on feeding tubes or supplements, and interference with psychosocial functioning.
Predisposing factors include choking episodes, medical conditions causing gagging, tube feeding history, and aversive experiences with medication.  The longevity and severity of symptoms of ARFID differentiate this condition from picky eating.

Diagnosis of ARFID can be made in both adults and children, with ARFID in children being diagnosed as early as 2 years. The journey to diagnosis can be significant for some children.

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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.

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In this episode of Inside Medical Nutrition, Dr. Linia Patel interviews Jacqui Lowdon, a paediatric specialist dietitian, about managing enteral nutrition patients in the community. Jacqui shares her journey into paediatric dietetics, starting with an interest sparked during a placement at a children's hospital. She discusses her current role as a clinical specialist in cystic fibrosis (CF) and her involvement with the British Dietetic Association.

The conversation delves into current trends in enteral nutrition, noting an increase in children with respiratory issues requiring long-term ventilation and tube feeding. Jackie explains the criteria for choosing a feed, considering factors like the duration of feeding, the patient's ability to take oral diets, and potential underlying conditions. She emphasises the importance of understanding the patient's overall nutritional needs and tolerance to support enteral feeding at home for children.

Jacqui highlights the evolution of available enteral feed formulas, from basic whole protein options to more specialised choices like fibre-containing, lower calorie, higher calorie, whey-based, and peptide-based feeds. She explains the use of peptide feeds for children who don't tolerate whole protein feeds and high-calorie feeds for those with high energy needs or limited tolerance for large volumes.

The discussion emphasises the crucial role of parents and carers in decision-making. Jacqui stresses the importance of open communication, considering cultural backgrounds and religious beliefs. She shares a case study illustrating the challenges of convincing resistant parents to switch feeds, ultimately succeeding through persistence and a bit of luck.

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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.

Annina Whipp joins us to talk about the ins and outs of setting up a blended diet service. For some, this process isn’t straightforward and there may be several obstacles in the way and things you may not have considered. Annina shares her experiences and reflects on the whole process, sharing her words of wisdom and some helpful tips for others thinking about setting up their own service.

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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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