Dietetics

Who to refer:

• Faltering growth: Please ensure history of growth measurements history included: see Primary Care Management section for advice on classification of faltering growth
• Food allergy including CMPA:
  • Please note peanut allergy should be referred directly to Medical Paediatrics.
  • Non-IgE CMPA –Cow’s Milk Protein Allergy (CMPA) – RefHelp (nhslothian.scot)
  • IgE CMPA
    • Advise to avoid cows milk protein and prescribe allergy formula if appropriate (Prescribing allergy formula’s)
    • If combination fed and infant did not previously react to cow’s milk in maternal diet please advise Mum to continue to keep cow’s milk in her diet.
    • Dietetics to provide skin prick testing on receipt of referral in order to confirm diagnosis. Dietetics to offer milk free weaning advice and reintroduction at 12 months as appropriate.
    • Please advise to avoid lactose free milks/products as these contain cow’s milk protein.

• Infants with nutrition related co-morbidity, for example: congenital heart disease, cleft palate, developmental delay
• Infants and children on home enteral tube feeds

Information to include in referral

• Current weight and height with trend/history
• Outline nutritional concern. For allergy patients, include allergy focused history
• Previous or current dietary interventions trialled
• Relevant medications i.e. anti-reflux, laxatives

How to refer:

• SCI Gateway: AHP – Dietetics >> Edinburgh – Royal Hospital for Children & Young People>> Edinburgh RHCYP

Who can refer:

• Medical staff, Nursing staff, Health Visitors, Specialist Nurses and AHPs

Who not to refer:

• Children aged 16 or over if not under Paediatrician: refer to Adult Dietetic Services
• Weaning advice: refer to Health Visitor
• Micronutrient deficiencies without growth concerns: advice sheets can be accessed in Resources
• Vegetarian/vegan diet without growth concerns: advice sheets can be accessed in Resources
• Constipation: see Paediatric Gastroenterology [LINK TO BE ADDED]
• IBS: see Paediatric Gastroenterology 
• Lactose intolerance: Information in Primary Care Management and advice sheets in Resources
• Non-coeliac gluten sensitivity: Information in Resources
• Obesity patients should be referred to Paediatric Weight Management – RefHelp (scot.nhs.uk)
• Nut allergy should be referred to Paediatric General Medicine – RefHelp (scot.nhs.uk)
• Selective eaters without faltering growth or other medical conditions
  • < 5 years: refer to Health Visitor. Information for parents in Resources
  • 5-15 years: Information for parents in Resources
• Selective eating as part of Autism Spectrum Disorder (ASD) Signposting information in Resources
• Gluten/casein free diet for children with autism

Avoidant Restrictive Food Intake Disorder (ARFID) if referral required, refer to CAMHS Eating Disorders

Classification of faltering growth:

Under 12 months of age, classified as one or more of the following:

• a drop of 2 or more weight centiles
• current weight <2nd centile
• length and weight greater than 2 centile spaces apart

Over 12 months of age, classified as one or more of the following:

• a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile
• a fall across 2 or more weight centile spaces, if birthweight was between 9th and 91st centiles
• a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile
• BMI below the 2^nd centile
• Height and weight greater than 2 centile spaces apart

Cows’ Milk Protein Allergy (CMPA)

Paediatric Cows Milk Protein Allergy (CMPA) – RefHelp (scot.nhs.uk)

Lactose Intolerance

Lactose free Diet Sheet v1 Aug 2019

Gluten challenge for those undergoing investigations for coeliac disease

Gluten challenge document March 2010

Vitamin D advice for HCPs:

http://intranet.lothian.scot.nhs.uk/Directory/infantfeeding/VitaminSupplementation/Pages/default.aspx

Nutrition

useful resources for parents e.g. fussy eaters and general advice on nutrition:

www.parentclub.scot explore by topic -> food & eating

https://raisingchildren.net.au/ nutrition section under every age group

www.firststepsnutrition.org/ general advice on weaning; vegetarian/vegan diets in children

Toddler and Infant Nutrition Advice – Infant & Toddler Forum (infantandtoddlerforum.org) general nutritional advice for young children

Increasing dietary iron advice leaflet https://www.bda.uk.com/resource/iron-rich-foods-iron-deficiency.html

Vegetarian/vegan diet factsheet

Parents can access advice sheet via https://www.bda.uk.com/resource/vegetarian-vegan-plant-based-diet.html

Lactose intolerance

Advice sheet for parents: Lactose free Diet Sheet v1 Aug 2019

Calcium in the diet

Calcium advice on a milk free diet (children)

Calcium and strong bones (children)

Vitamin D

Advice sheets for parents: Vitamin D and you (2021)  in English, Arabic, Chinese, Polish, Urdu: http://www.healthscotland.com/documents/5274.aspx

Non-coeliac gluten sensitivity

Advice available on:

https://www.coeliac.org.uk/information-and-support/coeliac-disease/about-coeliac-disease/gluten-sensitivity/

Healthy eating  

https://www.nhs.uk/healthier-families/

Families can also be directed to the free NHS food scanner app

Selective eaters advice leaflets for parents

Nutritional Advice for Fussy Eaters (Children under five years of age) Information for Parents and Carers – Nutritional advice for fussy eaters (children under 5 years of age)- Print Layout_190122.pdf or Nutritional advice for fussy eaters (children under 5 years of age)_email_read version_190122.pdf

Nutritional Advice for Fussy Eaters (Children over five years of age) Information for Parents and Carers – Nutritional advice for fussy eaters (children aged 5 years and older) – Print Layout_190122.pdf or Nutritional advice for fussy eaters (children aged 5 years and older)_read_emailversion_190122.pdf

Selective eating as part of ASD

ASD and eating difficulties leaflet for parents [PDF TO BE ATTACHED]

We recommend signposting parents/guardians to: https://sosapproachtofeeding.com/parent-workshop-when-children-wont-eat/

This workshop video offers an introductory view on how complicated feeding/eating is, why children may struggle to eat and how to help children eat better – practical strategies are discussed which aim to help caregivers teach their children to have a healthier relationship with food.

Other Resources recommended by specialist CAMHS dieticians include:

https://www.autism.org.uk/advice-and-guidance/topics/behaviour/eating/all-audiences

https://www.arfidawarenessuk.org  (ARFID awareness website)

And the following books:

• Food Refusal and Avoidant Eating in Children including those with Autism Spectrum Conditions – by Harris and Shea
• The Picky Eaters Recovery Book- by Thomas, Becker and Eddy
• ARFID, Avoidant Restrictive Food Intake Disorder, A guide for parents and carers – by Rachel Bryant-Waugh

For those children who have a diagnosis of ASD with selective eating, NHS Lothian and Edinburgh Council run a joint “ASD and Enabling Eating Parent Information Session.”

These sessions are available to:

• Parents/carers of pre-school children (0-5 year olds) and for
• Parents/carers of school aged children currently attending City of Edinburgh mainstream schools (primary and secondary.)

Parents can email and request the most recent flier for their next session:

Booking contact: 0131 469 2850

Email: autisminfo@ea.edin.sch.uk

Useful Links

Nutrition and Diet Resources UK https://www.ndr-uk.org/

British Dietetic Association https://www.bda.uk.com/