To refer to the Paediatric Dietetics service – please use SCI-GW: AHP – Dietetics >> Edinburgh – Royal Hospital for Children & Young People>> Edinburgh RHCYP.
Please don’t refer to General Paediatrics or Paeds GI for the sole purpose of arranging a dietetics review.
Information
The Paediatric Dietetic Service is a Lothian wide service which provides:
- Acute in-patient dietetic consultations at RHCYP, SJH, Simpsons Neonatal
- Out-patient clinics delivered across Lothian – City, East, Mid and West Lothian
- Home enteral tube feeding dietetic service for children (Centipaed)
A dietetic consultation encompasses a nutritional assessment and agreement of treatment plan, with review / ongoing follow up as required. A summary of the intervention is provided back to the referrer and care team.
Email advice for queries regarding the suitability of a referral is available on RHCYP.dietetics@nhslothian.scot.nhs.uk
Dietetic Secretary at Royal Hospital for Children and Young People: 0131 312 1075
JB & AC 31.12.21
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 (add link to appendix 2 – 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 2nd 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:
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) [PDF TO BE ATTACHED]
Calcium and strong bones (children) [PDF TO BE ATTACHED]
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:
Milk challenge to confirm suspected CMPA IMAP milk challenge to confirm CMPA.pdf
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/
