Blended diet for enteral feeds

This resource has been written by dietitians at Sheffield Children’s NHS Foundation Trust. It is designed to be used by those under the care of their home enteral feed (HEF) service. 

What does home enteral feeding (HEF) mean?

A significant number of children and adults are unable to eat by mouth and, as a result, need long-term home enteral feeding. This involves a tube being placed into the stomach or the start of the small intestine. The aim of enteral tube feeding is to make sure a person still gets all of the nutrients their body needs. Nutrients include the energy obtained from carbohydrate, protein and fat plus vitamins, minerals and trace elements.

The standard clinical practice is to use prescribed enteral feeds. These usually contain all the nutrients a person will need, as long as they have the full amount prescribed for them. They rarely cause tube blockages, are easy to prepare and give, and are sterile. However a growing number of people who are home enteral fed want fresh unprocessed foods as an alternative to mass produced and shop bought liquids for tube feeding.

What is a home blended diet?

Home blended diets are made by blending every day foods into a thin puree which you give through your child’s gastrostomy button. You can also give blended family foods alongside the usual prescribed feeds or on their own, provided they meet your child’s nutritional requirements. Your dietitian will discuss this with you.

What are the benefits of a blended diet?

There is very little scientific research in this area but through hearing the positive experience of others, some parents and carers want to try blended foods to see if it benefits their child.

Some children who have problems with tolerating prescribed feeds can manage larger amounts of blended diet with some reduction in symptoms such as reflux and retching.

What are the risks of a blended diet?

Tube blockage

Blended foods need to be the correct consistency to pass easily through the tube

Microbial contamination

To prevent food poisoning you should take in the preparation and storage of blended food. Feeding equipment needs to be cleaned and stored correctly.

Nutritional deficiencies

Some foods will need to be diluted (watered down) for them to be the correct consistency to pass through the button. This increases the amount they your child needs to meet their nutritional requirements which may cause them to have problems tolerating this higher amount of food.

Equipment needed for preparing blended food

• Weighing scales
• Clean utensils and work surface to prepare food
• Food thermometer
• Sieve
• Empty resealable food storage containers and labels
• Blender

There are 2 options for blenders:

High speed blenders

These are able to achieve a smooth consistency for most foods without the need to sieve the mixture. These blenders are more expensive.

Jug blenders and hand held blenders

These can be used but they are not able to cope with all foods, and especially raw foods. The mixture will need to be sieved before it goes through the gastrostomy button. A metal sieve is the best option.

Hand hygiene

Wash hands thoroughly before, during and after preparation of foods. Take particular care when handling raw meat, poultry, eggs or fish to avoid cross contamination of foods.

This NHS.uk advice gives more detail about effective hand washing.

Safe storage of blended foods

Storage after preparation

Homemade blended foods can be refrigerated for up to 24 hours. For safe storage of the foods your fridge temperature must be set between 1-4 degrees C. After 24 hours you must throw away any leftover feed.

1. Divide the blended foods into the required portions
2. Place in clean, separate lidded containers (ensure they are airtight)
3. Label feeds with the date and time and keep refrigerated until required.
4. Ensure blended foods are not left out at room temperature for more than 90 minutes before refrigerating
5. Blended foods must be used within 24 hours of preparation or they need to be discarded

Freezing blended foods

Alternatively, you can freeze homemade blended foods. Do this as soon as possible for safe storage. The freezer temperature must be set below -18 degrees C and you should use any frozen blended foods within 1 month.

1. Divide the blended foods into the required portions
2. Place in clean, separate lidded containers (make sure they are airtight)
3. Label feeds with the date it was made and place in the freezer
4. Make sure blended foods are not left out at room temperature for more than 90 minutes before freezing
5. Use within 1 month

Reheating

Before using any chilled or frozen blended foods it needs to be reheated to a minimum of 76 degrees C for at least 2 minutes to kill off any bacteria.

Frozen feeds should be fully defrosted in the fridge below 5 degrees C, and heated in accordance with information above. They need to be used within 24 hours of removing from the freezer.

Before feeding, allow the feed to cool to a suitable temperature (body temperature of 37 degrees C or below). The food should not be too hot or too cold as it will be delivered straight to your child’s stomach.

Blended foods should not stand at room temperature for longer than 90 minutes as this is the temperature where germs grow, which may lead to food poisoning.

Do not re-heat any foods more than once.