The Use of Blended Diets in Children With Enteral Feeding Tubes

Abstract

Objectives: This joint position paper of the Committees of Allied Health Professionals (CAHP) and Nutrition (CON) of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) provides a comprehensive guide for health professionals to manage blended diets in children via gastrostomy tubes. Methods: A systematic literature search was performed from 1992 to 2021 using Pubmed, MEDLINE, and Cochrane Database of Systematic Reviews and recent guidelines reviewed. In the absence of evidence, recommendations reflect the authors’ expert opinion. Final consensus was obtained by multiple e-mail exchange and virtual meetings of the CAHP and CON. Results: Reported benefits of blended diets include reduced GERD and infections, improved defecation, level of alertness and attention span, skin conditions, and appearance of hair and nails. Families report a sense of greater normality. Small case series, cross-sectional surveys, questionnaire-based small case studies, reports of personal experience, and single-center pilot studies are available in the medical literature. A total of 20 recommendations for practice were made based on the results and consensus process. Conclusions: There is little evidence published to formally inform about the potential health benefits or risks of this practice and how to use it in the best way. This leaves health professionals caring for such patients in a relative vacuum regarding what to consider when providing a duty of care to patients and carers who wish to pursue this method of feeding. This article provides guidelines for safe and appropriate use of a BD, but more research is needed.

A clinical consensus paper on jejunal tube feeding in children

“…Feeding into the jejunum bypasses the acidic environment and digestive mechanisms of the stomach, increasing infection risk 47,48 . There is insufficient evidence to support the use of nonsterile blenderized feeds in children receiving JT feeding 47,48 .…”

“…Feeding into the jejunum bypasses the acidic environment and digestive mechanisms of the stomach, increasing infection risk 47,48 . There is insufficient evidence to support the use of nonsterile blenderized feeds in children receiving JT feeding 47,48 . Furthermore, the consistency of blenderized or thickened feeds cannot be made completely homogeneous, increasing the risk of tube blockage 48 …”

“…47,48 There is insufficient evidence to support the use of nonsterile blenderized feeds in children receiving JT feeding. 47,48 Furthermore, the consistency of blenderized or thickened feeds cannot be made completely homogeneous, increasing the risk of tube blockage. 48 The decision to administer medication directly into the jejunum via a feeding tube should be guided by a physician, supported by a pharmacist or drug-prescribing guideline.…”

Clinical guideline highlights for the hospitalist: The use of blended diets in children with enteral feeding tubes

“…Further, there is data suggesting children have decreased emergency department visits and hospital admissions, as well as overall improved quality of life 5 . Despite these findings, many physicians continue to be hesitant of potential risks such as blockage and damage to the feeding tube, variability in delivery of calories and micronutrients, changes in medication absorption and the risk of infection or contamination from nonsterile diets 6 . However, given the growing popularity of BDs, these risks could be significantly magnified in the absence of medical support should families initiate a BD regimen on their own.…”

“…5 Despite these findings, many physicians continue to be hesitant of potential risks such as blockage and damage to the feeding tube, variability in delivery of calories and micronutrients, changes in medication absorption and the risk of infection or contamination from nonsterile diets. 6 However, given the growing popularity of BDs, these risks could be significantly magnified in the absence of medical support should families initiate a BD regimen on their own. Although currently uncommon in inpatient settings, the increasing use of this diet and potential health benefits necessitates clear guidelines for medical professionals.…”