The Use of Blended Diet with Enteral Feeding Tubes Practice Toolkit

The updated Blended Diet Practice Toolkit is a great example of collaboration of the BDA and BAPEN. This project, funded jointly by the two organisations, has involved a huge effort by those involved, with a thorough literature review of 49 identified papers which more than doubles the research evidence underpinning the previous version of the Toolkit. A UK survey of professionals and a series of roundtables further identified current knowledge and attitudes, along with barriers to extending best practice. A Position Statement was developed with 22 statements and 14 suggested actions for healthcare professionals. Invited case studies show how blended diets can be used both for children and adults. Importantly, there is a cohort of patients who have incorporated blended diets into their nutrition support as children and are now moving to adult care. The revised Practice Toolkit is the culmination of all those efforts and will help extend practice to those who would like to use blended diets safely and confidently. Congratulations to all who were involved in producing this revised guidance.

We are delighted, on behalf of the Parenteral and Enteral Nutrition Specialist Group and the BDA Paediatric Specialist Group, to introduce the third edition of The Use of Blended Diet with Enteral Feeding Tubes: Practice Toolkit. This edition has been jointly funded by both groups and BAPEN, reflecting our shared commitment to this important area of practice.

There has been significant progress in blended diet practice since the second edition was published five years ago. Dietitians want to support the patients they care for who choose a blended diet, and to do so with confidence. As its use grows, so does the need for dietitians, alongside the wider multidisciplinary team and multiagency colleagues, to develop the knowledge, confidence and practical skills needed to support informed discussions and deliver personalised care.

Blended diet is now firmly recognised as a legitimate feeding option for tube-fed people. It sits along a continuum of feeding approaches, from commercial enteral formula at one end to home-blended family meals as the sole source of nutrition at the other. Between these is a range of options, including commercial formulas containing food-derived ingredients, shop-bought food pouches, and a combination of home-blended feeds alongside commercial formula. These approaches are not fixed. Tube-fed people, their families and carers may move along this continuum over time, according to their preferences, circumstances and clinical needs.

At the heart of this Toolkit is a commitment to shared decision-making and personalised care. A particularly important development is the move away from formal risk assessment processes towards collaborative conversations that support informed choice, while ensuring that benefits and challenges are openly discussed. The question is no longer whether blended diet should be considered, but how to ensure that people have access to balanced information, expert guidance and the support they need to make decisions that are right for them.

This edition reflects the growing use of blended diet in adult services and extends into areas where practice continues to evolve, including nasogastric feeding, jejunal feeding, intestinal failure and pump feeding. The case studies support clinical understanding and offer valuable examples for navigating discussions in more complex situations.

A major strength of this edition is its practical focus. The ten appendices provide editable and printable resources for patients, families, carers and multidisciplinary teams. These include patient information leaflets, conversation guides, documentation templates, letters confirming the use of blended diet, and practical guidance on preparation and reheating. Together, they help translate guidance into everyday practice, supporting both experienced dietitians and those new to discussing or establishing blended diet.

This Toolkit will strengthen the confidence and capability not only of dietitians, but of all professionals who provide care and support to tube-fed people, their families and carers.

Finally, we would like to thank the authors and contributors of this edition. This encompasses a range of health professionals and people with lived experience, and their commitment has shaped this comprehensive update.

The BDA first published practice guidance on blended diet in 2013, followed by the first Practice Toolkit in 2015, titled ‘Liquidised Food via Gastrostomy Tube’. The guidance was updated in 2019, and the 2021 Practice Toolkit was retitled ‘The Use of Blended Diet with Enteral Feeding Tubes’. This third edition, a Position Statement and Practice Toolkit, keeps that title.

The 2026 review began in April 2025, led by Dr Sarah Durnan for the British Dietetic Association (BDA) together with BAPEN, reflecting a recognised need for a multiprofessional approach. The large team of co-authors and collaborators was selected for expertise in blended diet, and includes clinicians, academics and people with lived experience of tube feeding or of caring for a tube-fed person. The 2026 programme of work included a scoping review of the literature published since 2020, a UK survey of professionals, a survey of tube-fed people and their families, four practitioner roundtables, and case studies. An appreciative inquiry approach was used throughout the surveys, the roundtables and the case studies: contributors were invited to describe what worked and how they made it work, so these accounts describe successful practice. Each piece of work is reported separately with its own references.

This Practice Toolkit is the how-to for clinicians. It sets out how to support tube-fed individuals, their families and carers in their choices, with practical advice. The accompanying Position Statement presents the evidence and action points for commissioners, employers and care settings. It is hoped this Practice Toolkit will support equitable, person-centred care across the life course for tube-fed individuals in relation to blended diet.

The new evidence supports the 2021 core principles: blended diet is a legitimate option, shared decision-making is the basis for planning, and the risks are largely modifiable. The following has changed since 2021:

• Large comparative cohorts have examined the safety of blended diet in comparison with commercial enteral formula since 2021 (Part 1, scoping review).
• A risk assessment is no longer required for blended diet (Part 2, roundtables).
• The position on nasogastric tube feeding has been updated (Part 3, scoping review and case studies).
• The position on jejunal feeding has been updated (Part 3, scoping review and case studies).
• The position on stoma maturity has been updated (Part 3, roundtables).
• Advice on reuse of ancillaries (Part 4, scoping review).
• Food safety guidance has been strengthened on time and temperature control, ingredient safety and cleaning, and the reheating advice has changed (Part 7, scoping review and correspondence with the Food Standards Agency).
• Caution on over-reliance on food composition tables for calculating nutritional content (Part 6, scoping review).
• Greater detail on developing a monitoring plan, now including patient reported outcome measures (Part 10, scoping review).
• Greater detail on managing transition to adult care (Part 12, scoping review and the adult roundtable).
• This is the first edition to address adults directly (Part 12, scoping review and the adult roundtable).
• Guidance for settings other than the home has been expanded, with governance rather than clinical risk identified as the main barrier (Part 11, scoping review and roundtables).
• Blended diet may be used to support weaning from parenteral nutrition in intestinal failure (Part 8, scoping review and case studies).
• Pumps designed for blends are now available in the UK market. The 2021 edition recorded that pump manufacturers advised against pump use (Parts 4 and 9).
• The industry position has moved: the Enteral Products Safety Group accepts that some devices may be compatible with blended food under the advice of a healthcare professional (Part 3).

This Practice Toolkit has been developed to be read either from start to finish as an introduction to blended diet, or part by part, since each part relates to a different area of practice and can be read alone.

Cite as: Durnan S, Stanley R, Kennedy A, Kennedy D, Daniels R. The Use of Blended Diet with Enteral Feeding Tubes: Practice Toolkit. Birmingham: British Dietetic Association and BAPEN; 2026.

© 2026 Durnan, Stanley, Kennedy, Kennedy and Daniels, the British Dietetic Association and BAPEN. This Toolkit may be downloaded, printed and shared in full for clinical practice, education and local policy development, with full acknowledgement. The appendices are intended for local use and may be reproduced and adapted for that purpose, with full acknowledgement. No other part may be reproduced, adapted, translated or incorporated into another publication, in print or online, without the written permission of the lead author, on behalf of the authors, and the BDA and BAPEN.

If you have any questions about this toolkit, please contact [email protected].

The working group

Wider review

The draft Toolkit and Position Statement were read and commented on by twelve reviewers and by the four authors of the scoping review. Reviewers are listed in alphabetical order of surname.

Katie Angell, Senior Sister, Newcastle upon Tyne Children’s Community Nursing Team, The Newcastle upon Tyne Hospitals NHS Foundation Trust (scoping review author)

Kiranjit Atwal, Vice Chair, BDA Paediatric Specialist Group

Charlotte Bell, parent of a tube-fed child

Dr Anne Breaks, Clinical Specialist Speech and Language Therapist (Neurology), Guy’s and St Thomas’ NHS Foundation Trust

Linda Cantwell, Home Enteral Feeding Advanced Practitioner Dietitian, Mersey Care NHS Foundation Trust, and Chair, BDA Parenteral and Enteral Nutrition Specialist Group

Professor Jane Coad, Professor in Children and Family Nursing, Faculty of Medicine and Health Sciences, University of Nottingham (scoping review author)

Dr Jane Fletcher, Consultant Nurse for Nutrition and Intestinal Failure, Honorary Associate Professor, University of Birmingham, and incoming President of BAPEN

Ali Franks, parent of a tube-fed child

Heather Grant, Specialist Paediatric GI Dietitian, NHS Lothian, and Chair, BDA Paediatric Specialist Group

Dr Graeme O’Connor, Clinical Academic in Paediatric Dietetics, Great Ormond Street Hospital for Children NHS Foundation Trust, and Honorary Research Associate, UCL Great Ormond Street Institute of Child Health

Gemma Phillips, Senior Dietitian, Allied Health Professional Research Leader and Doctoral Fellow, Leicestershire Partnership NHS Trust and University of Leicester (scoping review author)

Rebekah Smith, Specialist Dietitian (ENT and Maxillofacial), University Hospitals Birmingham NHS Foundation Trust

Kate Stevens, grandparent and carer of a tube-fed child, and author of the Blended Diet Online website

Danel Tainton, Paediatric Dietitian, University Hospitals Dorset NHS Foundation Trust (Poole Hospital), and Chair, Dietitians Interested in Special Children (DISC)

Dr Susan Tomlinson, Research Fellow, University of Nottingham (scoping review author)

Adele Ward, Paediatric Dietitian, Princess Alexandra Hospital

Catriona Wright, Paediatric Dietitian in Gastroenterology, NHS Greater Glasgow and Clyde

This edition was funded by the British Dietetic Association, through its Paediatric and Parenteral and Enteral Nutrition Specialist Groups, and BAPEN, through its British Enteral Therapy Alliance Special Interest Group and Parenteral and Enteral Nutrition Group, which is a core group of BAPEN.

Authors’ declarations of interest are available on request.