Season 3

Information for Healthcare Professional Use Only 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. Finally, they discuss transitional care, emphasising the crucial role of multidisciplinary teamwork and communication. They stress the importance of a joint visit to ensure a smooth handover and address any concerns. The podcast concludes with a call for continued research and greater awareness of blended diets for patients requiring enteral nutrition. Listen to the full podcast episode to learn more about blended diets in transitional care and how best to support patients requiring enteral feeding.  

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 bacteria2,3,4. In addition, the combination of peptide-based feeds and fibre can help to improve tolerance and gastrointestinal symptoms.  Mikayla shares a case study where PHGG fibre supplementation significantly improved bowel motions and reduced medication reliance in a child with complex clinical conditions. She stresses the importance of a gradual introduction of fibre, monitoring tolerance through detailed symptom diaries, and involving parents in the decision-making process. She also points out the lack of standardised tools for fibre introduction, emphasising individualised approaches. Listen to the full podcast episode to learn more about fibre inclusion in enteral nutrition and the role it plays. 1.    Romano C, van Wynckel M, Hulst J, et al. J Pediatr Gastroenterol Nutr. 2017;65:242–264 2.    Ohashi Y, et al. Benef Microbes 2015;6(4):451-455.  3.    Yasukawa Z, et al. Nutrients 2019;11(9):2170.  4.    Reider SJ, et al. Nutrients 2020;12(5):1257.  

Information for Healthcare Professional Use Only 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. Smruthi emphasises the role of the International Dysphagia Diet Standardisation Initiative (IDDSI) framework in determining safe food and fluid textures. If a patient is deemed unsafe or silent aspiration is suspected, further instrumental assessments like video fluoroscopy or endoscopy are recommended. The podcast also explores the Eating, Drinking, and Swallowing Competencies Framework developed by the Royal College of Speech and Language Therapists (RCSLT). These competencies provide standards for knowledge, skills, and understanding for professionals supporting individuals with eating and drinking difficulties. Smruthi shares how these competencies have informed training programs and improved the quality of care for dysphagia patients. Finally, the discussion covers stroke rehabilitation guidelines, emphasising the potential for patients to benefit from rehabilitation at any point after their stroke. Smruthi outlines various rehabilitation options, including texture modification, behavioural  therapy, and exploratory muscle strength training. She underscores the importance of a collaborative, multidisciplinary team approach involving physicians, nurses, therapists, dietitians, and psychologists to support the patient's recovery journey. Smruthi highlights the importance of oral hygiene for stroke patients, following SLT recommendations, and stroke rehabilitation. Listen to the full podcast episode to learn more about dysphagia and how dysphagia is managed in stroke rehabilitation patients.

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. The conversation touches on the challenges of working in this field, including funding constraints and the need for ongoing education and support for dietitians. Marie emphasises the importance of staying informed about available products such as peptide feeds and being open to trying different approaches to manage patients with complex nutritional needs. Finally, Marie encourages healthcare professionals to reach out to experienced colleagues for guidance and support, recognising that each patient is unique and requires individualised care. The podcast concludes with a call for continued research and innovation in the field of enteral nutrition to improve outcomes for children with enteral feeding tubes. Listen to the full podcast episode to learn more about managing patients with enteral feeding tubes in the community using peptide feeds.  

Information for Healthcare Professional Use Only 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. The conversation also touches on the psychological aspects, emphasising the need for dietitians to be empathetic and understanding of the challenges families face. Harriet encourages open communication and tailoring advice to individual circumstances. The podcast concludes with a discussion of resources, including local food banks and grants, that can provide additional support to families struggling with the cost of blended diets. Listen to the full podcast episode to learn more blended diets in paediatric enteral nutrition. We also have a number of webinars on blended diets which you can watch to learn more and a further podcast on blended diets in transitional care.  

Information for Healthcare Professional Use Only 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. Listen to the full podcast to learn more about complementary feeding, weaning and allergen introduction for infants with food allergies. You may also be interested in this podcast with a specialist paediatric dietitian on managing enteral nutrition patients in the community.  IMPORTANT NOTICE: We believe that breastfeeding is the ideal nutritional start for babies and we fully support the World Health Organisation’s recommendation of exclusive breastfeeding for the first six months of life followed by the introduction of adequate nutritious complementary foods along with continued breastfeeding up to two years of age. We also recognise that breastfeeding may not be an option due to certain medical conditions. Parents should only feed Infant formula for special medical purposes under supervision of a healthcare professional after full consideration of all feeding options, including breastfeeding. Continued use has to be assessed by the healthcare professional in relation to the baby's progress bearing in mind any social and financial implications for the family. Infant formula should always be prepared, used and stored as instructed on the label in order to avoid risks to a baby’s health.  

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. 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 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. A key focus of Anaphylaxis UK is addressing the significant anxiety experienced by individuals with allergies and their families. Simon emphasises the importance of creating a supportive environment and working with businesses to implement allergy-friendly practices. He introduces the Business Forum, bringing together major brands to improve standards and communication. The organisation also collaborates with suppliers to ensure the safety and availability of allergy-friendly products. Simon stresses the need for a "no-blame culture" to learn from mistakes and improve allergy management. To learn more about the role of Anaphylaxis UK in allergy management and support listen to the full podcast episode. You may also be interested in this podcast with a specialist paediatric dietitian discussing weaning and allergen introduction.  

Information for Healthcare Professional Use Only 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. Jacqui's key takeaways include getting to know the patient and family, involving parents in discussions about enteral feeds, and recognising that enteral feed regimes can and should adapt to changing needs. She recommends utilising case studies and consulting with other dietitians to gain practical insights and support. She also stresses the importance of working with the family's routine and considering the child's whole day, not just the feeding schedule. Listen to the full episode to learn more about managing enteral nutrition patients in the community. You may also be interested in listening to this episode about using peptide feeds with enteral nutrition patients.