Children's Nutrition and Dietetics Service (Hounslow)

Lots of children experience fussy eating or food neophobia (fear of new foods) and this is completely normal. 

When to refer to the paediatric dietitians?

If a child is presenting with any of the below alongside fussy eating/restricted eating, it may be appropriate for the GP/healthcare professional to refer to a paediatric dietitian for further assessment:

• Significant weight loss or faltering growth
• Nutritional deficiencies diagnosed on a blood test
• Extreme restriction, e.g. less than 5 food items accepted

If a child presents with fussy eating, please direct parents to the below resources. We would recommend watching the NHS webinar on fussy eating below first.

If a child presents with fussy eating, please direct parents to our page on fussy eating.
 

If an infant or child needs help with weight gain and/or healthy eating advice there are lots of services and online resources available to help. 

Services available in Hounslow

Weaning

If a child is struggling with weaning, please speak with Health Visitors in your local area. Contact your GP to put you in touch if you are not being followed up by Health Visitors already

Fussy eating

If your child is a fussy eater, you can watch the NHS webinar on fussy eating:

Overview of Fussy Eating in Children (patientwebinars.co.uk)

Please see our section on fussy eating for more information on services and support available.

Healthy eating and lifestyle programmes - Beezee bodies

A service for 5-15 year olds where you can learn about healthy eating, exercise and wellbeing. They offer group sessions in person, online and also 1:1’s (if the child meets their criteria).

There is also a series of self-directed online courses which you can do in your own time at your own pace.

Click on the links below to learn more and enquire about signing up. The referral process is simple, and parents can also self-refer. There are forms at the bottom of these links. 

Beezee families (in person)

Beezee live (online)

Beezee families lite (1:1s)

Beezee academy (self-directed)

When to refer to paediatric dietitians

Aged 0-4 years AND
Weight >2 centiles above the height

Or 

BMI >98th centile

Useful online resources

Healthy eating

Healthy eating for children (British Dietetic Association)

Portion sizes

Guidance on portions for 1-4 years (First Steps Nutrition Trust)

Portion sizes for all ages (Caroline Walker Trust)

Your infant or child’s growth measurements - including weight, height and head circumference - will be assessed by plotting on one of the UK-WHO growth charts.

These charts show how we expect children to grow and can be found in your child’s ‘Red Book.’ They show the range of normal weights and heights, and how one child compares with other children of the same age and sex.

However, as humans we come in a range of shapes and sizes and all measurements that fall within the centile lines on the growth charts are considered ‘normal’. Normal growth and a normal weight does not necessarily mean growing, or tracking, along the 50th centile.

You may find that your child is growing well along one of the lower centiles and this may mean they look smaller and weigh less than many of their same age and sex peers. 

Children typically track and grow quite steadily in the absence of any problems. There is normally some natural movement within their normal centile position. It is also common for some weight to be lost when babies and children are poorly and unwell.

More important is the recovery weight gain that occurs once they are better - this is typically after about 2-3 weeks. Most children’s weight will be within 2 centile lines of their length or height centile position although some children will be further apart than this and thriving, although this is less common. 

The term 'faltering growth' is used to describe a pattern of slower weight gain than expected for age and sex in infants and preschool children, and it is most often due to inadequate nutritional intake.

When to refer to the dietitian

If there is more than 2 centile lines difference between height and weight (or weight loss observed and has crossed more than 2 centile lines), or ongoing static weight in a very young infant.

If recent weight loss has been observed which does not meet our threshold, we will direct parent/patient to helpful online resources (see below).

Additional useful thresholds used to assess weight faltering

• recent weight loss with a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile
• recent weight loss with a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles
• recent weight loss with a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile

Note on BMI

BMI below the 0.4th centile suggests probable undernutrition that needs further assessment (but may also reflect a small build in 0.4% of the thriving population).

BMI below the 2nd centile may reflect either undernutrition or a small build in 2% of the thriving population.

A referral for low BMI in isolation may not be accepted without additional supplementary information or concern from referrer such as: evidence of recent weight loss/failure to thrive, nutritional deficiency or concerns regarding current dietary intake.

Useful resources

For parents and carers

Guidance on appropriate portion sizes 1-4 years First Steps Nutrition Trust

Healthy eating for children (British Dietetic Association)

Portion sizes for all ages (Caroline Walker Trust)

For healthcare professionals

BMJ visual guide to management of faltering growth

NICE Guidelines Recognition and Management of Faltering Growth in children

We support infants, children, and young people with feeding tubes in the community including those with nasogastric tubes, gastrostomy tubes and jejunostomy tubes, including those on a blended diet.

Who do we see

We accept home enteral feeding patients who are registered with a Hounslow borough GP only (we do not accept Richmond borough GP). For Richmond Borough GPs please refer to Kingston Hospital paediatric dietitians: Paediatric Dietitians - Referral Criteria - Kingston Hospital

Below is a summary of the process required to accept a paediatric HEF referral in community dietetics. 

Paediatric home enteral feeding (HEF) discharge from hospital 

For a new paediatric HEF referral, for community dietetics referral we need the following: 
 
Before discharge

Hospital teams are required to: 

• Email dietetic team to notify of likely discharge (hrch.dietetics@nhs.net) 
• Register on Abbott e-reg (Abbott hospitals, community team will assist for out of area referrals)
• Request pump delivery (Abbott hospitals): hospital team to submit Abbott e-reg to Abbott to request pump delivery before discharge, before e-reg transfer to community team- this can be done without budget codes (if pump required) 
• Complete referral form and submit to single point of access: hounslowandrichmond.spa@nhs.net 
• Complete and send GP letter to request script for feed (to be delivered via Abbott Hospital to Home service - ABBOTT will contact GP to request prescription prior to first delivery)

On discharge

Hospital teams are required to: 

• Ward will need to provide 10-days supply of feed and ancillaries on the day of discharge (14-days supply will be required over Christmas and New year period) 
• Transfer Abbott e-reg to (Christina Hills) at Hounslow and Richmond HRCH Trust on discharge only (we will submit for first delivery once discharge is confirmed or on next working day if bank holiday or weekend) 
• Email final handover to: hrch.dietetics@nhs.net 

Please also ensure community nursing are aware and any other relevant teams, e.g. health visitors if weight monitoring is required. 
 
Please contact the dietitians team for further information.