Objective This prospective, observational study examined the accuracy of modular feed preparation for children with complex medical conditions requiring specialist feeds.

Methods and design Participants who regularly prepare special feeds at home were observed preparing two feeds with equivalent nutrient composition: a 2-ingredient (2-IF) and 6-ingredient feed (6-IF) under research-conditions, and 8 weeks later under home-conditions. The same feeds (2-IF and 6-IF) prepared by a trained feed-maker served as controls. Biochemical analysis of nutrient content was performed as an objective measure of feed preparation accuracy.

Results 52 participants were studied: one patient and 51 caregivers. Biochemical nutrient analysis was inaccurate for both feeds including control-feeds but was better for the 2-IF. Both feeds were lower in fat than the expected calculation but more so in the 6-IF than the 2-IF (median: 34% vs 84% of calculated research-condition values and 66% vs 90% home-conditions; p<0.0001). Conversely zinc was higher in the 6-IF than the 2-IF (median: 127% vs 87% research-conditions and 130% vs 89% home-conditions; p<0.0001). Preparation errors included: incorrect use of equipment, poor recipe adherence and ingredient measurement mistakes. Even in control-feeds there was equipment inaccuracy, poor ingredient emulsification and ingredient residue left in mixing/measuring containers. Fewer errors occurred with powdered than liquid ingredients.

Conclusions Many errors associated with special feed production are difficult to control. Carers of children with complex medical conditions require improved preparation equipment and techniques and the development of premeasured or combined ingredient preparations to maximise feed accuracy and minimise clinical risk.