Food-based enteral formulas in pediatric clinical practice: an expert opinion

Standard enteral formulas are widely used in pediatric practice but may be associated with gastrointestinal (GI) intolerance, limited food diversity, and caregiver dissatisfaction. Growing interest in whole-food feeding has led to increased use of blenderized tube feeds and commercially prepared food-based enteral formulas (FBEFs), although definitions, indications, and implementation strategies remain heterogeneous.

This expert opinion review summarizes available evidence and practice-based insights from an international, multidisciplinary panel of physicians and registered dieticians on the use of real-food enteral nutrition in pediatric clinical practice. The article was informed by a narrative literature review and a structured expert discussion. Key domains addressed include the definition of FBEF, physiological and psychosocial benefits, clinical indications, administration route and feeding modality, caregiver and cultural considerations, monitoring, transition to adult care, comparison with homemade blenderized tube feeding, and the emerging role of fully plant-based enteral formulas.

The current evidence, although largely derived from small observational studies, together with real-life experience in clinical practice, suggests that FBEFs are well tolerated and may improve reflux, retching, vomiting, bowel habits, and, additionally, caregiver-reported satisfaction. FBEFs offer standardized nutritional composition, food safety, shelf stability, and a lower preparation burden, while still aligning with families' preferences for food-derived ingredients. In our opinion, FBEFs represent a valuable option or children requiring long-term enteral feeding, particularly those with intolerance to standard formulas, provided that product selection, monitoring, and caregiver education are individualized.