Paediatric Nutrition and Dietetic Service

Overview

The Paediatric Nutrition and Dietetic Service is provided by UHBW. They provide an inpatient and outpatient service for all children and young people, from birth up until 19 years old (if in full time education), in the BNSSG area, and the South West, if under a specialist service.

They are mainly based at the Bristol Royal Hospital for Children (BRHC) but outreach to locations around Bristol, South Gloucestershire and North Somerset (including Weston General Hospital (WGH)) to provide an outpatient service.

If a child is at home, on long term enteral tube feeding, they will usually be looked after by the Home Management Service (HMS). HMS provides dietetic care for tube fed children and adults who have a GP within the BNSSG area. However, if the child is looked after by a specialist team, or the tube is only required for a short period (less than 4 weeks) their care may remain with the dietitian within the BRHC dietetic team. HMS is based at the Central Health Clinic in Bristol and will visit their patient’s in their homes or in some circumstances, their schools. More information about their service can be found at: http://www.uhbristol.nhs.uk/patients-and-visitors/your-hospitals/central-health-clinic/home-management-service-(hms)/

Specialist Services within UHBW

The UHBW Paediatric Nutrition and Dietetic Department work within a number of the multidisciplinary specialist teams at BRHC, WGH and the BNSSG community. These specialities are listed below and on our website: http://www.uhbristol.nhs.uk/patients-and-visitors/your-hospitals/bristol-royal-hospital-for-children/what-we-do/paediatric-nutrition-and-dietetics/

Referral Criteria

The UHBW Paediatric Nutrition and Dietetic Outpatient Service can provide help with the following:

• Constipation (please also see specific guidelines on Constipation)
• Cystic Fibrosis (must be under specialist team at BRHC)
• Diabetes (Type 1 and Type 2) (must be under specialist team at BRHC)
• Disorders of the gastrointestinal tract, such as malabsorption, coeliac disease, inflammatory bowel disease (IBD), Irritable Bowel Syndrome (IBS)
• Eating Disorders (referrals from CAMHS only)
• Faltering Growth
• Food Allergy (please see below for range of services available)
• Food Refusal, Restricted Diets, Avoidant Restrictive Food Intake Disorder (ARFID) (Please see Restricted Diet Pathway below)**
• Gastro-oesophageal Reflux (please also see specific guidelines on GORD)
• Inherited Metabolic Diseases (must be under specialist team at BRHC)
• Iron deficiency anaemia
• Ketogenic Diets (for treatment of epilepsy) (referrals from consultant paediatric neurologists only)
• Obesity/weight management (please see Weight Management Pathway)
• Oncology
• Vegan diets
• Weaning advice, if other problems present, such as faltering growth. For general weaning advice, parents/carers should be directed to their health visitor

** Additional Information Regarding Referrals for Food Refusal, Restricted Diets, Avoidant Restrictive Food Intake Disorder (ARFID)

Please note: there is no funded service in the BNSSG area for children with Extreme Food Refusal or Avoidant Restrictive Food Intake Disorder (ARFID). We are currently able to provide service for children with faltering growth (see NICE guideline 75) or diagnosed nutritional deficiency. We aim to assess the nutritional adequacy of the diet and make suggestions for improvements. Additional appointments are offered at the discretion of the managing dietitian for surveillance of the treatment plan. We are not able to offer behavioural interventions for food refusal/limited diets. 

This resource sheet can be used to signpost families to webinars and other resources to support them with their child’s diet. 

We welcome re-referrals if the child or young person’s diet has changed since their initial appointment and there are new concerns that they are not meeting nutritional requirements, however, this needs to be stated clearly on the referral.

Refer

Referrals to UHBW Paediatric Nutrition and Dietetic Service

We accept referrals from all health care professionals, preferably using the email address below:

DieteticsReferralsBRHC@uhbw.nhs.uk

We also accept referrals by post:

Department of Nutrition/Dietetics, Bristol Royal Hospital for Children, Paul O’Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ

Please include a clear reason for referral to our service along with a recent weight and height (no older than 4 weeks), any weight/height history, and relevant medical history.

To avoid unnecessary delay, please provide a current email address for the patient and ensure contact details are correct and up to date.

If you have any questions, please contact the UHBW Community Dietetics Team on 0117 3420811

Referrals to HMS

Referrals should be made to Dietetic services in the first instance who can refer into HMS services if long term tube feeding is appropriate (please note HMS do not start tube feeding in the community).  For any queries relating to existing tube fed patients please contact the service on HMS@UHBW.nhs.uk or ubh-tr.hmsbristol@nhs.net

Food Allergy

Before using this service please check existing guidelines on Food Allergy and Milk Related Problems which may provide the information you require.

Non IgE-mediated food allergies 

Cow’s Milk Protein Allergy (CMPA) 

Due to the COVID-19 pandemic, UHBW Paediatric Dietitians have been unable to run their face to face Cow’s Milk Protein Allergy Weaning Groups. In their place, a series of webinars have been recorded, offering the same information provided in the group session. An opt-in group virtual Question and Answer session with a Paediatric Dietitian is then offered to parents should they have any questions after watching the webinars.

In order to access the webinars, infants and children should be referred to our department, as previously, where they will go through a robust triage process. They will only be sent the webinars if considered clinically appropriate.

Referral criteria for webinars:

Inclusion Criteria

• Children aged 4 – 24 months old
• Diagnosed with CMPANon-IgE mediated allergy symptoms or, possible milk-related IgE symptoms but skin prick test negative

Exclusion Criteria

• Faltering growth
• Safeguarding concerns that indicate it would be better to see them in a 1:1 appointment
• Ig E-mediated CMPA

This can include children with multiple allergies but one of these must be CMPA to be eligible for the webinars.

Children unsuitable for the webinars will receive an individual appointment with a Paediatric Dietitian either face to face or by telephone.

Other non IgE-mediated food allergies 

All children with a non IgE-mediated food allergy that does not include CMPA will automatically be triaged to a 1:1 outpatient clinic appointment by the Paediatric Dietitians. 

Referrals for non IgE-mediated food allergies sent to the allergy team at BRHC, will be triaged and re-directed to the Paediatric Dietitians, if appropriate. 

For those children with an IgE-mediated allergy

These children should be referred to the Allergy Team at BRHC if allergy testing is required, via eRS. See ‘Clinical Guideline: Food Allergy – Management in Children’ for further information.

There is a Dietitian attached to the Allergy Team and the Allergy Team will refer to the Dietetic Service, where appropriate.

Weight Management

Please see the Weight Management Pathway for Children and Care of Childhood Obesity (COCO) clinic in Remedy.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.