How blended diet is introduced depends on individual feeding history: a child tube fed since birth has never been weaned, while an adult who ate until recently has a known history of tolerance to build on.
This part covers how to start and progress with blended diet. Support should be most intensive in the early weeks, when small and frequent adjustments are needed.
| Professionals new to supporting blended diet can draw on expertise elsewhere. Blended diet is well established across the UK, and the professional survey found most people supporting it learned from someone already doing it. Seek supervision from an experienced colleague, or from a specialist interest group or an established blended diet service where there is none locally. Nobody is expected to work it out alone. |
1. For infants, blended food can be introduced from around six months
In line with UK complementary feeding guidance, food (including blended food) can be introduced from around six months.
Start with 5 to 10ml of a single blended food mixed into the infant’s breast milk or current infant formula and increase slowly as tolerated. Introduce vegetables, fruit, starchy foods and protein one at a time, widening the range as tolerated.
Never add salt or sugar, and do not give honey before twelve months.
Introduce common food allergens, including egg, nuts, dairy, fish, wheat and soya, alongside other first foods from around six months and before twelve months.
Introduce them one at a time and give them regularly unless they cause a reaction.
Shop-bought puréed baby food allows a trial without buying a blender, though it can be higher in sugar and salt than a home blend.
2. Take care with common foods that cause allergies where the person was not weaned
An older child or adult tube fed with a commercial enteral formula since birth has no known history of food tolerance to build on, so introduce each new food one at a time and monitor for allergic reactions and intolerance.
Introduce the main food allergens one at a time in the same way. Introduce blended diet when the person is otherwise medically stable.
Start with a small amount and build gradually to an age-appropriate portion if tolerated, remembering that the gut needs time to adapt after a period on commercial enteral formula.
One strategy is to replace one commercial enteral formula feed with a blend at a time, for example at breakfast, with an interval between changes, so that tolerance can be judged.
Another, used instead or as well, is to mix a single blended food into the commercial enteral formula.
3. Build on what an older child, young person or adult ate previously
Someone who has eaten orally has a known history of tolerance and established likes and dislikes to build on, which an individual tube fed since birth does not.
Start from the foods they ate and enjoyed before tube feeding, and from what the household is cooking now. Where they still eat or taste some food by mouth, the blend can be the same food. Appendix 6 sets out the approaches for each starting position.
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Family meals People need practical advice to get started. Recipes can be helpful at the beginning to give ideas, but encourage adaptation of meals already prepared in the home, which reduces planning and preparation time. It also means the tube-fed person shares the same food as their family, one of the core benefits of blended diet. Often it is easier to establish blends at home first before considering other places where the person is fed. |
4. Weaning from parenteral nutrition is specialist led
Where blended diet is used to support intestinal adaptation and reduce dependence on parenteral nutrition, it is led by the specialist intestinal failure team.
Blends are introduced in small, consistent amounts, advanced slowly, and titrated carefully against the previous feed.
This is a newer application and the evidence rests on small case series and UK practice experience.
Symptomatic anastomotic ulceration has been reported in short bowel syndrome after the whole food fraction is increased. It is rare but serious, so where there is an anastomosis monitor for gastrointestinal bleeding and raise it with the intestinal failure team.
Weaning from parenteral nutrition in intestinal failure is described in the case studies.