Blended diet in enteral nutrition: expanding evidence, practice and providing patient- and family-centred care

Friday 12th Dec 2025

Blended diet, or blenderised diet, is becoming increasingly common in dietetic practice.[1,2] Over the last few years, NHD have covered various topics around provision of blended diet in hospital, at home and troubleshooting for dietitians. Blended diet is not a new practice but is growing in popularity, and as it does so, the evidence supporting blended diet for paediatric patients is expanding.[3,4] With the increase in interest and provision of blended diet, dietitians have been leading the development of guidelines, research into efficacy and management of patient and carer expectations.[5] As dietitians, we must first consider patient safety, how to ensure nutritional adequacy of blends and ensure patients and carers are heard and their viewpoints included.[6,2] Blended diet is not suitable for all patients but dietitians should be able to justify recommendations to ensure patient autonomy is respected, while navigating the ever-expanding research base.[7]

Why blended diet now? Why the change?

There has been a significant increase in the number of paediatric families exploring blended diets over the past decade, despite the practice itself existing for many years.[1,3] Several key factors now influence both family decision-making and professional opinion regarding this shift.

1. A push towards patient-centred care

Families frequently report that blended diets feel more “normal” and closely aligned with typical family mealtimes, promoting inclusion and emotional wellbeing for both children and carers.[2,8] Parents also describe feeling empowered by the ability to prepare food for their child, supporting autonomy and reducing the medicalisation of feeding.9 These perspectives align with wider movements towards patient-centred and relationship-centred care in paediatric nutrition.[7]

2. Growing reports of gastrointestinal tolerance

A growing body of evidence indicates that many children receiving blended diets experience improved gastrointestinal symptoms, including reductions in reflux, gagging, retching and constipation.[10,5] Improvements may relate to the higher viscosity, fibre content and diversity of whole foods, which can positively influence gut motility, tolerance and stool patterns.[11,1] Blended diets may also support a more favourable gut microbiota profile, contributing to reduced inflammation and improved GI function.[4,9]

3. Whole food trends and concerns about ultra-processed foods

Public awareness of whole food nutrition and concerns around ultra-processed foods (UPFs) has risen sharply in recent years, partly due to media coverage and social media influence. Families may therefore prefer food-based enteral options, perceiving them as more natural or healthier alternatives to commercial formulas.[6,11] While not all messages circulating online are evidence-based, these influences contribute to increased interest in blended diets.[9]

4. Availability of commercial formula alternatives

Commercially produced formulas containing whole food ingredients have become more widely available and provide an option for families seeking the benefits of blended diets without the full preparation workload.[11,10] Research suggests these products may offer similar improvements in GI tolerance for some children.[5] Additionally, companies have developed fresh-food blends in pre-prepared pouches, offering convenience for families during travel or when kitchen access is limited.[6]

Current evidence: what does the most recent research tell us?

While randomised controlled trials remain limited, observational studies, case series and qualitative research consistently demonstrate several key themes across paediatric populations receiving blended diets.[1,3]

1. GI tolerance and symptom relief

Multiple studies report improved gastrointestinal symptoms in children with complex medical needs after transitioning to blended diets, including reductions in vomiting, retching, reflux and gagging.[10,5] These improvements have also been observed in children with neurological impairment, severe gastro-oesophageal reflux disease and those dependent on gastrostomy feeding.[11,6] Proposed mechanisms include higher viscosity reducing reflux episodes, increased fibre content enhancing gut motility and reduced osmolality improving tolerance.[6,4]

2. Microbiome impacts

Early research suggests that blended diets may promote greater microbial diversity due to the wider variety of whole foods, fibre types and phytochemicals compared with commercial formulas.[3,4] Some studies demonstrate shifts towards more favourable microbial profiles and lower markers of intestinal inflammation, although further research is required to establish long-term clinical outcomes.[5,1]

3. Growth and nutrient adequacy

Evidence indicates that when blends are designed with dietetic oversight and reviewed regularly, children generally maintain stable growth trajectories.[6,5] However, studies also highlight that self-created blends without appropriate education can pose risks of macro- and micronutrient inadequacies.[3,12] Dietetic involvement therefore remains central to safe and nutritionally adequate blended feeding.[12,7]

4. Safety considerations

Food safety continues to be a key consideration when using blended diets but research shows that risks can be significantly reduced when families receive structured education on food hygiene, temperature control and hang times.[1,3] Studies also emphasise the importance of appropriate equipment, safe preparation methods and awareness of the potential for feeding tube blockages.[6,12]

The practical management and consideration of who is appropriate

Blended diet is not suitable for all patients and clear clinical criteria should guide decision-making. Current guidelines consistently state that children fed via nasogastric or jejunal tubes are not candidates for blended diets due to the narrow lumen, higher blockage risk and, in the case of jejunal feeding, the bypassing of the stomach and potential for dumping syndrome.[3,12] Some services also recommend allowing time for gastrostomy tract maturation before introducing blended feeds, with local policies advising on safe timelines.

Families require comprehensive education before starting a blended diet to ensure that they understand the commitment involved, including time for meal preparation and the need for appropriate kitchen equipment such as a high-powered blender.[7] Blended diets may also be unsuitable for children with fluid restrictions, severely compromised immune systems or those requiring precise nutrient delivery, such as certain metabolic conditions.[1,3] In these cases, decisions should be made collaboratively between the dietitian, medical team and family.[9]

Blends should generally be delivered via gravity bolus feeding to reduce the risk of pump malfunction and food contamination, as current feeding pumps are not designed for high-viscosity mixtures.[6] Some companies are working to develop pumps suitable for blended feeds, but until then, careful attention to consistency, tube size and hygiene is essential.[12]

Dietitians carry out formal risk assessments before blended diets are initiated and the British Dietetic Association (BDA) has developed tools to support this process.[1] Dietitians are responsible for establishing macronutrient targets, providing initial recipes and educating families about troubleshooting, particularly regarding tube blockage and food safety.[12]

Once commenced on blended diets, children should be monitored regularly by dietitians. This includes tracking growth to ensure adequate calorie intake, reviewing gastrointestinal symptoms and adjusting medications where needed.[5,6] Guidance should also be provided on managing illness, maintaining hydration and identifying when blood tests may be required to assess nutritional status.[3]

Equity, access and cultural considerations

Blended diets can enhance inclusivity and support culturally appropriate feeding practices but they also highlight inequities in access and resources.[9]Families may face financial challenges due to the increased cost of purchasing fresh ingredients and the need for suitable kitchen equipment, such as high-powered blenders.[13] Some families transitioning from long-term use of prescribed commercial formulas may be unprepared for the additional household food costs associated with blended diet.

Time is another significant barrier. Many carers of children with complex medical needs must also manage physiotherapy routines, medication schedules and appointments, leaving limited capacity for meal preparation.[2,13] These pressures can disproportionately affect families with lower incomes, limited support networks or higher caregiving burdens.[13]

Dietitians play a key role in promoting equitable care through education, practical strategies and culturally responsive dietary planning.[9] This includes helping families identify low-cost ingredient options, adapting recipes to respect cultural food preferences and advising on batch cooking to minimise cost and time demands.[3] Where necessary, dietitians may also support families in accessing food banks or community resources to ensure affordable access to fresh foods.[7]

A person-centred, culturally sensitive approach is essential to making blended diets both accessible and appropriate for the diverse families who may benefit.[2,9]

Conclusion

Blended diets are increasingly shaping the landscape of paediatric enteral nutrition, offering potential benefits such as improved gastrointestinal tolerance, enhanced quality of life, greater alignment with family and cultural practices and emotional satisfaction for both children and caregivers. For dietitians, blended diets present an opportunity to integrate clinical expertise with food-based nutrition and patient-centred care, bridging medical and lifestyle considerations.

When carefully assessed and supported through structured education, recipe development and ongoing dietetic monitoring, blended diets can be implemented safely and effectively across diverse paediatric populations. Risk management, nutritional adequacy and hygiene remain central to ensuring successful outcomes.

As research continues to evolve, dietitians are uniquely positioned to lead the integration of blended diets into clinical practice. This includes advocating for safe, equitable and meaningful nutrition options while respecting patient autonomy and supporting families in their decision-making. Through careful assessment, evidence-informed guidance and culturally responsive support, blended diets can provide a practical, person-centred alternative to traditional commercial enteral formulas, contributing to improved health and well-being for children reliant on long-term enteral nutrition.

Hazel is a Paediatric Dietitian with 19 years of experience. Her previous research has been around inflammatory bowel disease. She currently covers a wide area of specialities.

Hazel Duncan, RD

References

Anderson S.F, Gibson D and Thomson M, (2025) ‘Blenderized tube feeding for enterally fed children: systematic review of health outcomes and impact on upper gastrointestinal symptoms’, Journal of Pediatric Gastroenterology and Nutrition, 70(2), pp. 145–158
Baird C, Charlesworth Z. and Fallaize R. (2022) ‘Parental perspectives of blenderised tube feeding in the UK: A qualitative study’, Journal of Human Nutrition and Dietetics, 35(4), pp. 650–659
Borrelli O, O’Hare L, Smith C et al. (2022) ‘Nutrition and preparation of blenderized tube feeding in children and adolescents with neurological impairment: a scoping review’, Nutrition in Clinical Practice, 37(5), pp. 1023–1034
Frost G, Law S and Desai M. (2022) ‘Impact of blended diets on the gut microbiome: emerging evidence and practical implications’, Journal of Human Nutrition and Dietetics, 35(S1), pp. 15–22
Gallagher K, Flint A and Mouzaki M. (2022) ‘Blenderised tube feeds vs. commercial formula: which is better for gastrostomy-fed children?’, Nutrients, 14(15), p. 3139
Desbrow B, Carson N and Bunya V. (2020) ‘Outcomes and safety of blenderized tube feedings in paediatric patients: a single-center experience’, Journal of Pediatric Gastroenterology and Nutrition, 71(4), E124–E128
YourTube Study Group (2024) ‘Risks, benefits, and resource implications of different diets in gastrostomy-fed children: The YourTube mixed-method study’, NIHR Health Technology Assessment, 28(12), pp. 1–162
Jacobi S, Johnson R, and Kelly P. (2021) ‘Cultural and social considerations in paediatric feeding: implications for blended diets’, Maternal & Child Nutrition, 17(4), e13218
Lee S, Tsang A, and Lam C. (2018) ‘Homemade blenderised tube feeding: Clinical outcomes, caregiver experiences and cost implications’, Clinical Nutrition, 37(6), pp. 2119–2126
Pentiuk S, O’Flaherty T, Santoro K. et al. (2011) ‘Pureed by gastrostomy tube diet improves gagging and retching in children with fundoplication’, JPEN Journal of Parenteral and Enteral Nutrition, 35(3), pp. 375–379
Hron B, Fishbein M and Lien E L. (2019) ‘Whole food–based enteral formula improves gastrointestinal symptoms in children receiving long-term enteral nutrition’, Journal of Pediatric Gastroenterology and Nutrition, 68(1), pp. 70–75
Pettifor M, Steele C and Graham A. (2023) ‘Risk assessment and safety frameworks for paediatric blended diets: A UK specialist service evaluation’, Clinical Nutrition ESPEN, 54, pp. 345–352
Brown H, Kowalski A and Carnell J. (2020) ‘Whole-food enteral formulas and their role in paediatric feeding’, Clinical Nutrition ESPEN, 38, pp. 276–283