A practical guide to blended diet with an enteral feeding tube
Last edited: 29/06/26
You are receiving this leaflet because your dietitian has discussed the possible use of a blended diet for you or someone you care for. A blended diet uses home-prepared foods rather than commercial tube feed products. It can be used on its own or alongside commercial tube feeds. The term blended diet (BD) refers to the overall diet, while blends refers to individual meals or recipes.
The use of BD has been linked to a range of possible benefits, including:
- improved gastro-oesophageal reflux, retching and vomiting
- improved bowel habits, which may help reduce constipation and diarrhoea
- improved tolerance of tube feeds
- increased tolerance of larger feed volumes
- healthier-looking skin, hair and nails
- improved cognition
- increased involvement in family mealtimes and social occasions
- an improved sense of normality
- benefits for parents and carers through preparing and providing food for a child, family member or person they support.
However, BD is not suitable for everyone. There are some potential risks and concerns, including:
- not meeting nutritional requirements
- potential tube blockages
- concerns about food hygiene and food safety
- increased costs for food and equipment
- increased time and skill needed to prepare food.
Making a shared decision
It is important that any decision to start BD is made jointly between:
- you, where possible
- your family or carers
- your dietitian
- your local medical team.
A shared discussion allows any questions or concerns to be raised before a decision is made. Your dietitian should lead these discussions and provide advice based on the individual's medical condition and nutritional needs.
How to start a blended diet
Starting BD will depend on age, medical history and the support available. Ideally, BD should be introduced at home when you or the person you care for is medically stable. Take time to make sure you have the equipment you need and think about how you will get started. It can take time to build confidence with preparing and giving blended meals.
Infants and very young children
- BD can usually be started from around six months of age if a suitable feeding tube is in place
- start with a small amount of a single-ingredient blend mixed with the infant's usual formula or milk, for example 5ml to 10ml
- gradually increase the amount and variety of foods while reducing formula as larger volumes are tolerated
- stage one baby foods can be a simple way to get started
- follow general weaning advice
- introduce common allergenic foods, such as eggs, nuts, dairy products, fish and wheat, before 12 months of age.
Children and young people who have been tube fed since birth
- ideally, a bolus feeding pattern should be established before starting BD
- start slowly with single foods and introduce a new food every few days
- build variety gradually over time
- monitor for any reactions to foods
- begin with small amounts and increase the volume gradually
- introduce foods earlier in the day, such as at breakfast.
Children, young people and adults who have previously eaten food by mouth
- start with foods that were previously eaten, beginning with favourite foods where known
- the amount given and the speed of change will depend on how long it has been since food was eaten by mouth
- the longer it has been, the more gradually BD should be introduced.
A typical meal pattern of three meals and two to three snacks each day can help you plan when to give BD. You may choose to give only one blended meal or snack each day and continue to use formula or commercial feeds for the rest of your nutritional needs. Your dietitian will work with you to develop a plan that meets your individual needs.
Nutritional adequacy
It is important to make sure you or the person you care for receives a balanced diet when using BD.
A nutritious, balanced diet provides the nutrients needed for growth, healthy bones, a strong immune system and overall health and wellbeing. BD should include a range of foods from different food groups.
One of the benefits of BD is that it can help you or the person you care for take part in family mealtimes. A good place to start is to think about the foods already eaten by the rest of the family.
Important points when starting BD
- aim to provide a similar amount of calories and protein to that provided by the commercial feed
- speak to your dietitian if you are unsure how many calories or how much protein is needed, as requirements may change once BD is established
- once established on BD, aim for at least three meals each day
- if only small volumes can be tolerated, extra snacks between meals may be needed to meet calorie requirements
- some people may need between four and seven blends each day
- use a nutritious liquid such as commercial formula, cow's milk or dairy alternatives including soya, oat or coconut milk when starting BD, as these can provide extra calories and protein
- if larger volumes are tolerated and weight remains stable, water, stock or juice can also be used
- the timing and amount of BD may vary around school, work, holidays and other activities
- tolerance may vary throughout the day, so the volume of BD may need to be adjusted at different mealtimes
- a weekly meal plan can help provide a good variety of foods and nutrients.
Healthy balanced diet
The Eatwell Guide can help you plan a balanced diet that provides a range of nutrients. Please note that the Eatwell Guide is based on the needs of an average healthy adult. Portion sizes and energy requirements may need to be adapted to meet individual nutritional needs. For more information about each food group, visit the NHS Eatwell Guide.
Planning meals
Each main BD meal should include foods from the following groups.
Protein
Protein foods include beef, pork, chicken, eggs, cheese, pulses and nuts.
Protein is important for:
- growth in children
- maintaining the body in adults
- recovery from infection
- wound healing
- maintaining muscle mass and strength.
The amount of protein needed will depend on age, medical condition and whether weight gain is needed. Protein requirements may also change over time. Your dietitian can advise how much protein is needed.
Starchy carbohydrates
Starchy foods include bread, pasta, rice, potato, sweet potato, couscous, barley and other grains. These foods are the body's main source of energy and fibre. However, they absorb liquid and can make BD thicker. Because of this, you may need to use smaller amounts than would normally be eaten by mouth. Other carbohydrate sources, such as honey, jam, syrup, molasses and sugar, can be added if extra calories are needed.
Fruit and vegetables
Fruit and vegetables provide vitamins, minerals, fibre and water. Fresh, frozen and tinned fruit and vegetables can all be used. Aim to include two to three different types in each meal where possible. Choosing a variety of colours can help provide a wider range of nutrients.
Fats and oils
Fats and oils include extra virgin olive oil, avocado, cream, butter, tahini and nut butter. These can be particularly helpful if weight gain is needed or only small volumes can be tolerated. You may choose to use oils such as avocado, coconut or hemp oil. However, standard olive or vegetable oil provides a similar amount of energy and is often more affordable.
Nutritious liquids
Nutritious liquids include:
- commercial formula
- cow's milk
- dairy-free alternatives
- coconut milk
- gravy
- juice.
These can provide calories, protein and other nutrients while also helping achieve the correct consistency.
Snack meals
Snack meals can include one or two food groups, such as:
- fruit and yoghurt
- vegetable soup with beans
- baked beans on toast
- biscuits and milk
- fruit purée
- yoghurt
- cow's milk.
Portion sizes
The amount of food needed and the suggested volume of each blend will vary depending on:
- age
- the volume that can be tolerated
- activity levels or the amount of movement
- medical conditions that increase or reduce energy requirements
- any special dietary requirements, such as a ketogenic diet or milk-free diet
- whether the person receiving BD is able to communicate when they feel full.
When starting BD, it may be helpful to be cautious with portion sizes and increase them gradually as tolerance is established.
A simple way to estimate portion sizes is to use the individual's hand size as a guide. This can help you judge an appropriate portion based on age and body size. However, this is only a guide and may need to be adjusted depending on volume tolerance, weight gain or weight loss.
If you would like more detailed information about portion sizes for different age groups, the following resources may be helpful:
- https://www.firststepsnutrition.org/eating-well-early-years provides advice for children under five years old
- https://www.cwt.org.uk/publications/ include portion sizes, food weights and photographs for four age groups, from infancy to 18 years
- https://www.myplate.gov/eat-healthy/what-is-myplate provides guidance on healthy eating and portion sizes for different age groups.
Energy
Once BD has been fully established, aim to provide a similar amount of energy (calories) to that provided by the commercial feed. This can help prevent unwanted weight gain or weight loss.
Some people find they need more calories when using BD. If weight gain is needed, see the section on weight gain and speak to your dietitian for advice.
Blended meals usually require extra liquid to achieve the correct consistency. This can reduce the energy density of the feed compared with commercial formula. You may need to add energy-rich foods to help meet calorie requirements.
Further advice can be found in the problem-solving section.
Fluid and hydration
Try to provide a similar amount of fluid to that received through the commercial feed, including any water flushes.
Additional water flushes may be needed because blended feeds can contain less fluid than commercial feeds. However, blended meals do contain a significant amount of water. On average, a blend is around 75 per cent fluid.
It is important to stay well hydrated. One way to monitor this is by checking the colour and appearance of urine. Ideally, urine should be pale yellow or straw coloured. Darker or strong-smelling urine may be a sign that more fluid is needed.
Other signs of dehydration include:
- dry skin or lips
- fewer wet nappies or pads
- darker, strong-smelling urine
- increased constipation
- more urinary tract infections
- increased fluid losses, such as drooling, loose stools or sweating.
During warm weather or in centrally heated environments, extra water flushes may be needed. You can also increase fluid intake by adding water or other nutritious liquids to BD.
Vitamins and minerals
A well-balanced BD should provide the vitamins and minerals needed without requiring a multivitamin supplement. However, some people find a supplement reassuring when moving from commercial formula to BD.
Once established on BD, meals can be adjusted to increase nutrients that may be lacking and reduce any nutrients being provided in excess.
Vitamin D supplementation is recommended for everyone between October and March. The recommended dose is 10 micrograms (400 IU) each day.
Vitamin D supplementation may be needed throughout the year for:
- people who use a wheelchair
- people who are mainly housebound
- children under five years old.
Some people may be advised to take a higher dose. Speak to your healthcare professional if you are unsure.
Flavour
Do not be afraid to add herbs, spices and other flavourings to blends. Some people report being able to taste their meals, and flavour can help make mealtimes more enjoyable.
Nutrition tracking
Apps and websites can help you check whether nutritional needs are being met.
Useful tools include:
- Explore Food
- MyFitnessPal.
Tracking can be helpful:
- when starting BD
- if nutritional needs change
- if blood tests show low or high levels of vitamins or minerals
- when weight gain or weight loss is required.
It is not necessary to track every day. This can be time-consuming and may take the focus away from achieving a healthy, balanced diet.
Equipment needed for blending
The following guidance outlines the types of blenders and equipment that can help make preparing BD easier.
You may be able to buy a refurbished blender from a second-hand seller. Always check electrical safety before use. Some charities may be able to help with funding. Speak to your local team, such as your dietitian or social worker, for information about available support.
Blenders
Stick blender
Advantages:
- easy to use
- easy to clean
- inexpensive.
Disadvantages:
- lower power than other blenders
- may struggle to blend foods such as nuts and seeds
- best suited to smaller volumes
- can be messy to use
- requires a suitable blending container
- food may need to be sieved after blending.
Mid-range blender
Examples include Nutribullet and Nutri Ninja.
Advantages:
- easy to use
- easy to clean
- suitable for preparing individual meals.
Disadvantages:
- not ideal for batch preparation
- durability may vary between models.
Commercial blender
Examples include Vitamix, Omniblend, Blendtec and Oster. A blender with a minimum power of 900 watts is recommended.
Advantages:
- powerful enough to blend most foods
- suitable for large quantities and batch preparation
- often includes self-cleaning functions
- long product warranties are common
- generally durable.
Disadvantages:
- higher initial cost
- can be noisy.
Portable blender
Advantages:
- useful for travel and days out
- usually rechargeable.
Disadvantages:
- limited power
- may not blend some foods effectively.
Other equipment
Jug
Always transfer feed into a jug before drawing it into a syringe. Do not syringe feed directly from the blender jug, as this could cause injury from the blender blades.
Metal sieve
Choose a sieve with fine holes, ideally around 1mm.
When starting BD, sieving blends can help remove lumps and reduce the risk of tube blockages. A small conical sieve may be easier to use and may reduce food waste.
Some foods, such as certain meats, seeds and fruit with pips, may require sieving even after blending.
As confidence increases, you may find sieving is no longer necessary. However, sieving can remove some of the fibre from blends.
Syringes
Sixty millilitre syringes are usually recommended because they provide the correct pressure and hold a suitable volume of feed.
Syringes with a single, thin O-ring are often easier to use and may last longer than those with thicker double rings. A small amount of cooking oil can be used to lubricate the plunger if needed.
Extension sets
If you use a low-profile button, a right-angled extension set may help reduce the risk of blockages by catching small lumps. Straight extension sets can also be used.
Storage containers
Freezer-safe food containers, bottles and pouches can be useful for storing prepared blends in the fridge or freezer.
Paper towels
Paper towels can be placed over the end of an upright syringe when tapping out air bubbles. This helps prevent feed from spraying out.
Water for flushing
Prepare syringes of water in advance for flushing the tube. Use freshly drawn tap water unless your healthcare team advises otherwise.
Consistency of BD
BD meals should have a smooth, thin purée consistency. Aim for the texture of pouring cream, smooth yoghurt or runny honey. A blend with the correct consistency should:
- contain no lumps or pieces of food
- run easily from a spoon
- not hold its shape
- fall through the prongs of a fork
- not leave a clear fork pattern on the surface
- allow a plastic teaspoon to stand upright briefly when the spoon head is fully covered.
Blends that are too thick can be difficult to give through a feeding tube. Blends that are too thin may make it harder to provide enough nutrition within a suitable volume.
| Foods that are easier to blend | Foods that can be more difficult to blend |
|---|---|
| root vegetables, such as carrots, swede and parsnips | seeds |
| slow-cooked lean meats | nuts |
| fish with a creamy or milk-based sauce | fruit with skins or pith, such as oranges |
| stewed fruit that softens during cooking, such as apples and pears | fruit with very small seeds, such as raspberries, which may not blend completely and can increase the risk of tube blockages |
| good-quality minced meat with less gristle and fewer stringy parts | lower-quality minced meats with higher amounts of gristle |
| smooth yoghurt without pieces of fruit |
Useful store cupboard items
- vegetable oils
- smooth nut butters
- chocolate or nut spreads
- honey
- smooth soups
- tinned fruit
- tinned vegetables
- tinned beans and pulses
- UHT milk
- dairy-free milk alternatives
- smooth baby food pouches
- cooking sauces
- puréed meals.
Administration
It is recommended that BD is given using the bolus feeding method. If BD is given using a specialist feeding pump, it should not hang for longer than two hours.
Make sure the stoma site and gastrostomy are clean before and after feeding.
Before you begin
This is an example only. Your dietitian will advise you on the best approach for your individual needs.
Wash your hands and all equipment thoroughly before starting.
You will need:
- freshly drawn tap water or cooled boiled water
- a 60ml syringe for water
- an extension set, if using a low-profile button
- a 60ml syringe for feed
- blended feed
- paper towels or tissues.
Phase one – free water
This step is optional, but some people find it helps improve tolerance to blended feeds.
- Connect the extension set to the button
- Give the recommended amount of water using gravity or a syringe
- Remove the extension set
- Wait at least 45 minutes before giving the feed
Some families find that giving water before a blended feed helps prepare the stomach for food and supports hydration.
Phase two – feed
- Attach the extension set to a syringe and fill with water
- Connect the extension set to the button
- Draw up 60ml of feed and gently tap the syringe to remove air bubbles
- Wipe the outside of the syringe with a clean tissue
- Give the feed into the gastrostomy at approximately 1ml per second using gentle pressure on the syringe plunger
- Repeat until all of the feed has been given
If you use a PEG tube, flush with water before giving the blend.
Aim for the feed to take about the same amount of time as it would take to eat the meal by mouth.
Phase three – flush
- Flush the tube with at least 10ml to 15ml of water using a push-stop-push-stop technique. Larger volumes may be needed
- Remove the extension set, if used
- Close the gastrostomy button cap
Preparation, storage and reheating
The same food safety principles used when preparing food to eat by mouth should be followed when preparing BD.
Basic food hygiene training is available online, often free of charge. For more information, visit the Food Standards Agency food safety guidance.
Preparation
When preparing BD:
- wash your hands before handling food or equipment and throughout food preparation
- follow the UKHSA handwashing guidance for good hand hygiene
- clean all cooking and blending equipment thoroughly according to the manufacturer's instructions
- make sure all food preparation surfaces are clean
- store food correctly and use it before the use-by date
- keep raw and cooked foods separate
- cook foods thoroughly before blending.
Storage
If food needs to be stored before use:
- keep blended food in a clean container with a lid, a freezer-safe bag or a covered dish
- store cooked and ready-to-eat foods above raw foods in the fridge
- cool food as quickly as possible before refrigerating
- do not leave blended food at room temperature for more than two hours
- reduce this time during hot weather
- refrigerate or freeze food if it will not be used immediately
- store blends in the fridge below 5°C for up to 24 to 48 hours
- discard any blend that has been refrigerated for longer than 48 hours
- do not transfer old refrigerated blends to the freezer
- defrost frozen blends in the fridge below 5°C
- use a fridge thermometer where possible
- freeze blends below -18°C for up to one to three months
- freeze blends in portions to make them easier to use
- label each blend with its ingredients and preparation date.
Frozen blends can sometimes appear thicker or lumpier after thawing, particularly if they contain starchy foods. Mixing thoroughly with a small amount of hot liquid can help restore the correct consistency.
Reheating
Pre-cooked meals
To reheat prepared blends:
- remove the blend from the fridge and transfer it to a suitable container
- heat until steaming hot throughout
- if using a thermometer, ensure the blend reaches at least 70°C for two minutes
- stir thoroughly before use
- use within two hours of reheating
- allow the blend to cool to a suitable temperature before administration
- blends can be given at temperatures up to approximately 50°C, which is similar to a warm cup of tea
- warmer blends are often easier to administer as they become thinner
- once cooled, add a nutritious liquid or some of the planned water flush if needed to achieve a runny honey or pouring cream consistency.
Foods usually eaten cold
For foods such as desserts, fruit blends and baby foods:
- cold foods can be given cold if preferred
- allow refrigerated feeds to stand at room temperature for around 30 minutes before use
- alternatively, place the container in a jug of hot water for up to 10 minutes
- stir or shake well before feeding.
Defrosting
When defrosting blended feeds:
- thaw overnight in the fridge or use the microwave defrost setting
- do not thaw at room temperature
- if using a microwave, stir thoroughly and allow to cool before use
- stop halfway through defrosting to stir and ensure even heating
- reheat thawed blends following the guidance above
- use thawed blends within 24 to 48 hours
- do not refreeze defrosted blends
- do not return warmed blends to the fridge
- discard any reheated blend not used within two hours
- when transporting chilled food, use a cool bag with ice packs to maintain a temperature between 0°C and 4°C
- return food to a refrigerator as soon as possible.
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