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 intolerance, limited food diversity, and caregiver dissatisfaction. Growing interest in whole-food feeding has led to increased use of blenderized tube feeds and food-based enteral formulas (FBEFs), although definitions and implementation strategies remain heterogeneous.

This expert opinion review summarizes evidence and practice-based insights from an international, multidisciplinary panel of physicians and dieticians on the use of FBEF in pediatric clinical practice. The article was informed by a narrative literature review and a structured expert discussion. Key domains addressed: definition of FBEF, physiological and psychosocial benefits, clinical indications, administration route, transition to adult care; in comparison with homemade blenderized tube feeding.

The current evidence, together with real-life experience in clinical practice, suggests that FBEFs are well tolerated and may improve reflux, vomiting, bowel habits, and, 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 viable option for children requiring long-term enteral feeding, particularly those with intolerance to standard formulas, provided that product selection, monitoring, and caregiver education are individualized.