Listen: Managing Enteral Patients & Peptide Feeds with Marie Watson

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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 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 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.

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 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 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 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.

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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