Paediatric Dietitians – Referral Criteria


Please note: this information is intended for Healthcare Professionals

The Paediatric Dietitians are based at Kingston Hospital and Raynes Park Centre (Kingston Hospital satellite clinic). We accept outpatient clinics referrals from GPs, Health Visitors, School Nurses and SLTs in Kingston, Richmond and Twickenham. Some GP practices within the Kingston Borough have in-house Dietitians who provide a local service and referrals can also be made to these clinics. Please check with your relevant GP dietitian regarding which patients they are able to see.

We also accept referrals from internal services based at Kingston Hospital e.g. NNU, Paediatricians and specialist nurses.

Unfortunately, in view of recent staffing difficulties we have had to review our referral criteria and redefine who we will see, to ensure that we prioritise dietetic care for those who need it the most. Therefore, we regret we can no longer accept referrals for weight management, fussy eating with no associated growth faltering or serious medical complications, and referrals for patients based in Surrey, with a Surrey GP postcode.

Please note the following:

  • Email the dietetic service (khft.dietetics@nhs.net) with patient’s name, DOB, NHS or Hospital (MRN) number and clear reason for referral. We do not have a specific form to be completed, to ensure the referral process is user friendly, but please do include weight and a height with centiles clearly documented to evidence any growth faltering. If you do not specify clear centiles/measurements, there is a chance that your referral will be rejected.
  • Paper referrals are no longer accepted. We will not accept new referrals for patients whose care already falls under West Middlesex, St George’s or Epsom/St Helier’s.

Referrals for food allergies:

  • We accept all referrals for single milk allergies (both IgE and non- IgE mediated) and egg allergy.
  • Referrals for other food allergies or multiple food allergies should be made to the Paediatric Consultants at Kingston Hospital or Paediatric Allergy Clinic at Kingston Hospital.  
  • We will continue to accept referrals for multiple food allergies from our Kingston Hospital Paediatricians once the appropriate assessment and testing has been conducted by them.
  • We will not see patients for allergy testing or food challenges purposes only.

Home enteral feeding patients:

We provide a Home enteral feeding service to Kingston, Richmond and Twickenham Boroughs. Tube-fed patients in Kingston are under the care of Fiona Bryant and Tube-fed patients in Richmond fall under Louisa Fogg (Home enteral feeding paediatric dietitians, both are based at Kingston Hospital).

Cancellations, rescheduling and non-attendances (DNAs):

  • Given increasing waiting times for our clinics, patients will be allowed to reschedule an appointment a maximum of 2 times whilst under our care.  Rescheduling on the day will be allowed once (unless there are exceptional circumstances). Patients will be discharged back to the referrer after this and will need to be referred back to dietetics.
  • Patients who DNA with no notice will be discharged back to their GP/ referrer after one missed appointment.  In the case of children who are considered at risk or have a child in need/ child protection plan, the social worker/health visitor/GP will be contacted and an attempt to reschedule with the patient will be made a second time. If they DNA again, we will discharge them back to the care of the GP.
  • This will apply to both new patients and follow ups.

Our contact details are as follows:

khft.dietetics@nhs.net
(all referrals to be emailed)

Paediatric Dietitians,

First Floor Vera Brown House,

Galsworthy Road,

Kingston upon Thames,

KT2 7QB

Tel: 0208 973 5280 (direct line to Paediatric Dietitians if you have any questions)  

Appointments/admin queries: 0208 973 5277 (Dietetic administrator: Titi Oshad).

Referrals accepted by Paediatric Dietetics (Outpatients)

 Urgent (within 4 weeks)*As soon as possible (within 8 weeks)*Routine (3-4 months)*
Growth Faltering – Poor weight gain (evidenced with centile chart and weight history)* (*Non-nutritional causes and Paediatrician referral should also be considered)<1 year<2 years>2 years Restrictive Eaters on background of ASD / Sensory difficulties / ARFID
Food Allergies Non-IgE Cow’s Milk Protein Allergy <1 year Confirmed other / multiple food allergies (referred by Paediatrician) <1 yearNon-IgE Cow’s Milk Protein Allergy >1year Confirmed other / multiple food allergies (referred by Paediatrician) <1 year
Food intolerances
(e.g. lactose or wheat)		  1 appointment only
Reflux WithCow’s Milk Protein Allergy and/or faltering growth 
Tube-fed patientsThose patients will be seen by the HEF team.
Coeliac Disease *GP referrals to be sent to Paediatrician in first instance[PA(HNFT1]  Confirmed new diagnosis who haven’t been seen by a dietitianConfirmed diagnosis seen by a dietitian e.g. in GP clinic (or in Coeliac Clinic)
Iron Deficiency Anaemia (associated with poor diet)  1 appointment
Constipation[PA(HNFT2]  (if associated with poor diet)  1 appointment

*Dependent on appointment availability

Other Dietetic clinics

  • Weight Management Clinics – Currently suspended
  • Children with Type 1 or Type 2 Diabetes will be seen by Sue Thomas (Paediatric Diabetes Dietitian) as part of the Diabetes Team.
  • Children seen in MDT Paediatric Allergy Clinics will be seen by the dietitian covering on the day.
  • Children with Coeliac Disease will be followed-up in dietitian-led coeliac clinic.
  • Neonatal clinic – Exclusively booked by the dietitians for ex pre-term follow-ups.

Referrals that will NOT be accepted

Referrals not accepted by the Paediatric DietitiansAdditional information/1st line advice can be found below:
General Fussy Eating behaviour  http://www.infantandtoddlerforum.org https://www.bda.uk.com/foodfacts/healthyeatingchildren.pdf
Autism without associated feeding difficultiesAutism Society: http://www.autism.org.uk
NHS website: http://www.nhs.uk/livewell/autism/pages/parentsguidetoautism.aspx  
Checking calcium adequacyThe Dairy Council: https://www.bda.uk.com/foodfacts/Calcium.pdf http://www.milk.co.uk/publications/default.aspx
See our diet sheet on Kingston hospital website re dietary fibre and fluids intake.  
Mild – moderate constipationNICE guidelines: Constipation in children and young children. Diagnosis and management of idiopathic childhood constipation in primary and secondary care http://guidance.nice.org.uk/CG99
NHS website:    http://www.nhs.uk/planners/birthtofive/pages/constipation.aspx
ERIC website: https://www.eric.org.uk/advice-for-children-with-constipation
See Kingston hospital webpage: https://kingstonhospital.nhs.uk/healthcare-professionals/paediatrics-referrals/patient-information-leaflets-paediatrics/  
General nutritional assessment / Nutritional analysis of food diaryYou are welcome to refer those patients to a private dietitian
Eating Disorders (diagnosed anorexia nervosa, bulimia) Please refer to relevant eating disorder service or to CAMHSNHS website:
http://www.nhs.uk/conditions/eating-disorders/pages/introduction.aspxBEAT website: https://www.beateatingdisorders.org.uk/  
Eczema – without associated food allergies or faltering growthNICE guidelines: Atopic eczema in children http://guidance.nice.org.uk/CG57NICE guidelines: Diagnosis and assessment of food allergy in children and young people in primary care and community settings http://guidance.nice.org.uk/CG116See Kingston Hospital webpage: https://kingstonhospital.nhs.uk/healthcare-professionals/paediatrics-referrals/eczema/Preventallergies (Australian site): https://preventallergies.org.au/healthcare-professionals/  
Other suspected IgE mediated food allergies including Egg and Nut allergy  Allergy UK: https://www.allergyuk.org/childhood-food-allergy/childhood-food-allergyBSACI:https://www.bsaci.org/professionalresources/resources/paediatric-allergy-action-plans/ and https://www.bsaci.org/professional-resources/resources/Preventallergies (Australian site): https://preventallergies.org.au/healthcare-professionals/Patients can be referred to the allergy clinic at Kingston Hospital for assessment and management  
Food Challenges or allergy testingPatients requiring ward food challenges or allergy testing should be referred to the Allergy clinic for assessment and management.
Patients with food allergies already referred to a different paediatric allergy service outside Kingston HospitalPlease refer to the dietitians from the same service to provide continuity of care
Loose Stools (unless diagnosed with Cow’s Milk Protein Allergy or Lactose intolerance)NICE guidelines: Diagnosis and assessment of food allergy in children and young people in primary care and community settings http://guidance.nice.org.uk/CG116    
Preterm babies WeaningBliss website:     http://www.bliss.org.ukOr refer to the Health Visiting Team for further support  
Reflux (unless associated with faltering growth and suspected Cow’s Milk Protein Allergy)NICE guidelines: Gastro-oesophageal reflux disease in children and young people: diagnosis and management https://www.nice.org.uk/guidance/ng1
Swallowing Difficulties  Refer to community Paediatric Speech and Language Therapist for feeding assessment
Vegetarian & Vegan Diets (except where faltering growth evident)NHS website: http://www.nhs.uk/Planners/birthtofive/Pages/Vegetarianandvegankids.aspxVegetarian society website http://www.vegsoc.org/health/ First steps Nutrition: https://www.firststepsnutrition.org/eating-well-early-years  
Weaning and eating well in early years  BDA website: https://www.bda.uk.com/resource/complementary-feeding-weaning.htmlFirst steps Nutrition: https://www.firststepsnutrition.org/eating-well-early-years  
Weight ManagementHENRY programmes HENRY programme for 1-5 year olds, currently only accepting referrals through School Health service. HENRY Healthy Families Growing up programme is for parents, (of children aged 5-12), and is delivered online across 8 weeks, with resources and videos alongside the main online parent session. HENRY referral form (office.com) – Full link: https://forms.office.com/Pages/ResponsePage.aspx?id=zb3fDnScB0i–_qy39bzPPGbsbtk7ZlGvHVSTBjDxJ5UMk04MFc3S1BYQ01BNEZVSTJWVTZITTE3RS4u&wdLOR=c914AD4DA-0A65-4A5C-B9D6-94435DDEE5A3
Get Active for 16yo + Connected Kingston – Full link: https://www.connectedkingston.uk
SEND Local Offer website lists support and activities for young people with disabilities: https://kr.afcinfo.org.uk/local_offer & Short Breaks Team can advise on support in accessing activities for these individuals: https://kr.afcinfo.org.uk/pages/local-offer/information-and-advice/short-breaks/about-short-breaks# 

You may also find the following resources helpful when providing 1st line advice:

https://kingstonhospital.nhs.uk/healthcare-professionals/paediatrics-referrals/

You will find:

BDA (British Dietetics Association)

https://www.bda.uk.com/food-health/food-facts.html

  • These are free and can be printed as required.  There are a number available including basic milk and wheat allergy advice, calcium, Iron and vitamin D advice.
  • There is also some helpful information general healthy eating, packed lunches, food and mood and weaning.

Coeliac UK website for general Coeliac information: https://www.coeliac.org.uk/

Allergy UK is also an excellent source of fact sheets for various food allergies and intolerances and information regarding allergy testing and how to proceed with introduction of common allergens when weaning: https://www.allergyuk.org/

Patient-friendly advice on introduction of food allergens when weaning and on eczema management:  https://preventallergies.org.au/

The Infant and Toddler Forum has helpful information about weaning, toddler diets and fussy /restrictive eating and is also a good resource for professional education: https://www.infantandtoddlerforum.org/

Resources for ARFID:

https://www.arfidawarenessuk.org/

FEED EAT SPEAK (private service, set up by a SLT, also run webinars) https://www.feedeatspeak.co.uk/

Paediatric referrals (Healthcare Professionals)

Paediatric referrals (Healthcare Professionals)

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