Information for Healthcare Professional Use Only In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel speaks with Mikayla Profe-Fuchsloch, a dietitian and assistant professor at the University of Coventry, about the impact of fibre inclusion in enteral nutrition for paediatric patients. Fibre, which is classified by solubility, viscosity, and fermentability, increases stool weight, improves bowel regularity, and can balance stool frequency in both diarrhoea and constipation cases. All these features make it a useful addition to enteral nutrition. It is not uncommon when managing paediatric patients with complex medical needs to have issues related with the gastrointestinal system.  There can be issues with gut dysmotility and symptoms such as gastroesophageal reflux, delayed gastric emptying, diarrhoea and constipation. In clinical practice, adding in a fibre supplement or choosing a fibre containing enteral feed can help to manage these issues. Current guidance from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition on how much fibre per day paediatric patients require recommends an increased fibre intake in children with neurodisabilities of 17-21g of fibre per day.1 This may be provided by the fibre from an enteral feed as well as the addition of a fibre supplement.  Fibre supplements that are partially hydrolysed, such as Partially Hydrolysed Guar Gum (PHGG), which can help to improve bowel motions1. PHGG has been shown to work as a prebiotic, supporting the growth of beneficial gut bacteria2,3,4. In addition, the combination of peptide-based feeds and fibre can help to improve tolerance and gastrointestinal symptoms.  Mikayla shares a case study where PHGG fibre supplementation significantly improved bowel motions and reduced medication reliance in a child with complex clinical conditions. She stresses the importance of a gradual introduction of fibre, monitoring tolerance through detailed symptom diaries, and involving parents in the decision-making process. She also points out the lack of standardised tools for fibre introduction, emphasising individualised approaches. Listen to the full podcast episode to learn more about fibre inclusion in enteral nutrition and the role it plays. 1.    Romano C, van Wynckel M, Hulst J, et al. J Pediatr Gastroenterol Nutr. 2017;65:242–264 2.    Ohashi Y, et al. Benef Microbes 2015;6(4):451-455.  3.    Yasukawa Z, et al. Nutrients 2019;11(9):2170.  4.    Reider SJ, et al. Nutrients 2020;12(5):1257.  

Information for Healthcare Professional Use Only In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Smruthi Venkat, a speech and language therapist (SLT) specialising in stroke rehabilitation. They delve into the complexities of dysphagia, swallowing difficulties commonly experienced by stroke patients. Smruthi explains that stroke patients present with varying swallowing impairments depending on the location of the stroke. These can include oral motor weakness, sensory deficits affecting the ability to distinguish food temperatures or detect residue, and impaired coordination of the four-stage swallowing process. The conversation highlights the importance of early swallow screening for stroke patients upon hospital admission. If difficulties are detected, a specialist assessment by a speech and language therapist is crucial. This bedside swallowing assessment involves a detailed case history, cranial nerve and oral motor examination, and observation of the patient consuming different food and fluid textures. Smruthi emphasises the role of the International Dysphagia Diet Standardisation Initiative (IDDSI) framework in determining safe food and fluid textures. If a patient is deemed unsafe or silent aspiration is suspected, further instrumental assessments like video fluoroscopy or endoscopy are recommended. The podcast also explores the Eating, Drinking, and Swallowing Competencies Framework developed by the Royal College of Speech and Language Therapists (RCSLT). These competencies provide standards for knowledge, skills, and understanding for professionals supporting individuals with eating and drinking difficulties. Smruthi shares how these competencies have informed training programs and improved the quality of care for dysphagia patients. Finally, the discussion covers stroke rehabilitation guidelines, emphasising the potential for patients to benefit from rehabilitation at any point after their stroke. Smruthi outlines various rehabilitation options, including texture modification, behavioural  therapy, and exploratory muscle strength training. She underscores the importance of a collaborative, multidisciplinary team approach involving physicians, nurses, therapists, dietitians, and psychologists to support the patient's recovery journey. Smruthi highlights the importance of oral hygiene for stroke patients, following SLT recommendations, and stroke rehabilitation. Listen to the full podcast episode to learn more about dysphagia and how dysphagia is managed in stroke rehabilitation patients.

Dr Rosan Meyer, a Paediatric Dietitian, discusses the Cow’s Milk related Symptom Score (CoMiSS) and how it can help healthcare professionals to be more aware of symptoms related to Cow’s Milk Allergy (CMA) and support the diagnosis of CMA. You can access the CoMiSS tool here. Information for Healthcare Professional Use Only