The Blended Diet for Tube Feeding in School
Progress since the Turkey Twizzler
The impact of unhealthy school dinners on children’s health, wellbeing and education has been an ongoing debate since 2005 when celebrity chef Jamie Oliver ran the TV series Jamie’s School Dinners. Improvements have been made since the time of the infamous Turkey Twizzler, but more progress is needed. Oliver is still at the forefront of the campaign with his charity Bite Back 2030, calling for all schools in England to publish annual food reports showing progress against measures of health and nutrition.
Blended diet for school dinner
When the conversation changes from eating orally to using a feeding tube, the debate understandably changes. The fundamental starting point of the debate however does not. A feeding tube is not a reason not to have the same healthy balanced diet than that recommended to the rest of us. It is true that other factors may mean that a specialised diet may be needed, that requirement should be understood and catered for based on the best information and research on the condition that is available, rather than the feeding tube being treated as a condition in itself.
The ‘Blended Diet’ is exactly as it sounds, you blend everyday food to a consistency allowing it to be pushed through a feeding tube. Formula feeds have commonly been used for people with a feeding tube but there is growing support and interest in a blended diet. This trend toward real food is not surprising to most people. Few people would describe a formula made of sugars, oils, protein powders and supplements to be a ‘healthy well balanced diet’ for one meal let alone every meal for the rest of your life.
The growth in popularity and use of the blended diet starts from the reasoning that a well-balanced diet is better for us. This is exactly the same case that Jamie Oliver and his supporters have been making since 2005. The logic is supported in reality with countless accounts from people of how symptoms like reflux, diarrhoea and constipation reduce or stop and people look and feel healthier with more energy after moving to a blended diet. The academic research is growing and further supporting the anecdotal account of people using the blended diet, all of which increases its popularity and growth.
The story unfortunately doesn’t end there. There is no getting away from the fact that with the blended diet comes some challenges. It is time consuming; the equipment can be expensive, and it can be difficult to get a blend with a good consistency for tube feeding that is still nutritious and balanced.
Overcoming the challenges and the importance of School
Many people overcome these challenges, motivated by the benefits (Peers E, Boocock RC, Burn N. A systematic review examining the impact of blended diets on the gastrointestinal symptoms of people who are enterally fed. J Hum Nutr Diet. 2022 Sep 21. doi: 10.1111/jhn.13090. Epub ahead of print. PMID: 36129232.), which far outweigh the effort . Outside of the home however, even the most motivated and prepared can hit barriers outside of their control. One such barrier can be a school setting. The Covid-19 pandemic brought into sharper focus just how critical schools are in a young person’s life and it reaches far beyond education. The lines between education, social care and health have blurred but often in the centre of it all is the school. Feeding a pupil a blended diet is a good example of how this looks in practice for a pupil and a school.
Parents have put huge efforts into creating nutritious blended food for their child, they have seen the benefits it brings and cannot accept these improvements being undone because a school doesn’t feel able to support a blended diet. I have seen this frustration manifest itself in comments like ‘you don’t need to check a kids sandwiches when they bring a packed lunch!’ Schools are already stretched way beyond the remit of education and strive to do the best for their pupils. School leaders have a duty of care and the blended diet brings new challenges around food safety, preparation and training. To do this, support is needed from specialists and healthcare professionals and often that is not available. This gives a school little choice but to say no to the blended diet even if they do want to support its use with their pupils.
These challenges are not insurmountable and there are schools around the country who have worked hard with the local authority and healthcare professionals to support the blended diet. These schools are in the minority and the policy development and training is inconsistent and has a long way to go. Best practice from these progressive and well supported schools needs to be collected to create the necessary resources needed to provide the consistency for pupil choice that should exist.
A head teacher told us:
A head teacher told us “We are a mainstream primary school and currently have two tube fed pupils in the school. We have been able to support the parental choice of offering a blended diet and have met with dietitians to ensure that we have a clear risk assessment. From our perspective, there is very little difference for us in delivering a blended diet rather than a formula. I was surprised to hear that so many schools are concerned about supporting a blended diet. Packaged meals like Wilbo’s Blends reduces the risk of managing blended foods coming in from home and provide a manageable solution for day to day provision. Another concern that we did have was if there was a spillage of the blend, what would we be able to provide instead? Thankfully this hasn’t happened yet! ”
Even where schools are well supported and do deliver a blended diet to pupils, inequality between oral and tube feeding pupils can still exist. Universal free school meals for all pupils in England up to year 2 was introduced by government to help promote good nutrition in children. An admirable policy designed to ensure that children get a high quality, nutritious meal each day, in reality the policy means all ‘oral eating children’
Innovation is here
Innovation in blended diet products is now available and removes some of the risk and challenges associated with the blended diet in schools. Wilbo’s Blends produce 100% organic real food meals designed specifically for tube feeding. Sealed packets that are stable and ready to go at room temperature mitigate many of the food safety concerns. Schools who currently feel they cannot support the blended diet should revisit their policy on the blended diet and consider how Wilbo’s Blends can allow the choice of blended diet whilst broader policy is developed on the subject..
