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Infants, children and young people in Eastern Devon with or without medical diagnoses who present with a feeding or eating problem.
Common feeding issues that can usually be managed in primary care by universal services.
Breastfeeding/bottle feeding difficulties:
Toddlers and younger children
Older children and young people
Many feeding behaviours in infants and younger children are part of typical feeding development and are usually transient. Children displaying a significant number of these behaviours or displaying behaviour to a greater extent for a prolonged period may be considered to have a 'Feeding Difficulty'. In other words, it is not merely the presence of behaviour but the severity and duration of behaviours that signifies a problem.
Breast/bottle feeding difficulties:
Weaning difficulties :
Toddlers and younger children
Older children and young people
1. Asses growth
Always measure weight and length/height, plot on a RCPCH growth chart to identify whether growth faltering is a problem
2. Consider the cause
Is the problem…
Giving appropriate nutrition?
Taking appropriate nutrition?
Using appropriate nutrition?
3. Decide whether invstigations are needed
Growth assessment, examination and history-taking are the most important tools in determining cause. Any medical investigations should be directed by symptoms.
The following blood tests may be helpful where there is growth faltering or chronic gastrointestinal symptoms but other investigations may be appropriate depending on symptoms and signs:
4. Is it urgent?
Rapid identification and treatment in cases of Anorexia Nervosa is essential for good long term outcomes. If you suspect a child or young person of having Anorexia Nervosa, please refer to CAMHS at an early opportunity. Guidance for whether joint referral to paediatrics is appropriate can be accessed here
5. Can the problem be managed in primary care?
In cases of transient feeding or eating difficulties, particularly in younger children, reassurance about growth and a discussion about normal development will help reduce anxiety and support parents to move forward.
The Health Visiting team (under 5s) or School Nursing team (school age children) have a wide knowledge of normal childhood feeding, and can trouble shoot difficulties, particularly in
6. Who can you refer onto?
Feeding or eating difficulties can occasionally be the first symptom of a significant medical condition. A referral to paediatrics for feeding difficulties is warranted for:
Where feeding difficulties are causing a significant risk to quality of life or physical health, and impacting on growth and development, children may meet the threshold for specialist single agency services:
Service remit – assessment or advice for: Diagnosis of autistic spectrum condition
Service Exclusions: A request for the service will not be accepted if there is not clear evidence that the child or young person has signs or symptoms that are expected for ASC or when a Paediatrician or Psychiatrist does not support the request
How to refer: Autism Spectrum Assessment Service
Service remit – assessment or advice for: Idiopathic constipation affecting feeding in children and young people who have not responded to initial treatment within 3 months.
Service Exclusions: Children where constipation is not affecting feeding, or who have not undergone treatment in primary care for at least 3 months
How to refer: Bladder & Bowel Service
Service remit – assessment or advice for:
Service Exclusions: Children with behavioural feeding problems which are not significantly impacting on the child's mental or physical health
How to refer: Child and Adolescent Mental Health Services (CAMHS)
Service remit – assessment or advice for: Growth nutritional adequacy
Service Exclusions: Children with difficulties managing or refusing textures , amounts or types of food where there are no growth concerns and some foods from each food group are consumed
How to refer: e-Referrals
Service remit – assessment or advice for: Sensory postural fine motor skills
Service Exclusions: For general OT exclusion criteria see toileting request criteria
How to refer: Occupational Therapy
Service remit – assessment or advice for: Feeding behaviour secondary to a medical diagnosis
Service Exclusions: Children not under the care of paediatrics, and those without a medical condition causing behavioural feeding concerns
How to refer: Referrals must come from a paediatrician
Service remit – assessment or advice for: Behaviour under 5s neurodevelopmental
How to refer: Specialist Children's Assessment Centres
Service remit – assessment or advice for: Children presenting with mechanical eating, drinking and swallowing problems who are under the care of a paediatrician
How to refer: Dysphagia request criteria page
Service remit – assessment or advice for:Breastfeeding
Service Exclusions: Older children (over 1)
How to refer: Devon Infant Feeding Clinic
There are no multidisciplinary clinics to assess feeding difficulties in Eastern Devon, apart from the Virgin Care Eating Disorder service (CAMHS + medical and dietetic support from RDE Paediatrics).
The following groups are more likely to receive support from multiple agencies, which will include some MDT working, though this is not necessarily formalised:
Normal School Age Feeding
MindEd or Families has online advice and information from trusted sources and will help families to understand and identify early issues and best support their child.
https://www.rcpch.ac.uk/resources/growth-charts" target="_blank">Royal College of Paediatrics and Child Health
MindEd has mental health orientated e-learning applicable across the health, social care, education, criminal justice and community settings. It is aimed at anyone from beginner through to specialist.
This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.
Publication date: February 2017