Paediatric Dietitians – Referral Criteria

Please note: this information is intended for Healthcare Professionals

The Paediatric Dietitians are based at Kingston Hospital and Raynes Park Health Centre (Kingston Hospital satellite clinic). We accept outpatient clinic referrals from GPs, Health Visitors, School Nurses and SLTs in Kingston and Richmond. 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 the increased demand and waiting lists 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 selective/fussy eating with no associated growth faltering or nutritional/serious medical complications, and are also unable to accept referrals for patients with an out of area GP.

Referral process:

Email the dietetic service (khft.dietetics@nhs.net) with the 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 height history (with centiles) and clearly documented any evidence of 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 another local hospital (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 (HEF) patients:

We provide a Home enteral feeding dietetic service to families registered with a Kingston or Richmond GP. The Paediatric HEF Dietitians are based at Kingston Hospital (Fiona Bryant provides the service for the Kingston area and Louisa Fogg the service for the Richmond area).

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 Dietitia

Appointments/admin queries: 0208 973 5277

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 year	Non-IgE Cow’s Milk Protein Allergy >1year Confirmed other / multiple food allergies (referred by Paediatrician) <1 year
Selective eating with evidence of growth faltering or other serious medical, nutritional or social concerns	<1 year	<2 years	>2 years Restrictive Eaters on background of ASD / Sensory difficulties / ARFID
Food intolerances (e.g. lactose or wheat)			1 appointment only
Reflux		With Cow’s Milk Protein Allergy and/or faltering growth
Tube-fed patients	Those patients will be seen by the HEF team.
Coeliac Disease *GP referrals to be sent to Paediatrician in first instance		Confirmed new diagnosis who haven’t been seen by a dietitian	Confirmed diagnosis seen by a dietitian e.g. in GP clinic (or in Coeliac Clinic)
Iron Deficiency Anaemia (associated with poor diet)			1 appointment
Constipation (if associated with poor diet)			1 appointment
Weight management (BMI ≥ 99.6^th centile or BMI ≥ 91^st centile with co-morbidity; high weight or rapid inappropriate weight gain in children <2 years old)			Opt-in system (except if safeguarding concerns or child in need plan in place)

*Dependent on appointment availability

Other Dietetic clinics

Weight Management specialist clinics – Currently suspended
Children with Type 1 or Type 2 Diabetes will be seen by Donna Van Zyl (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.

Sources of additional information and support for children and young people that we are unable to see:

Referrals not accepted by the Paediatric Dietitians	Links to additional information/1^st line advice that may be useful for health care professionals and/or families:
Selective/fussy eating without growth faltering or nutritional/social/ serious medical concerns	Infant & Toddler Forum: Fussy and Faddy Eating in Toddlers Archives – Infant & Toddler Forum (infantandtoddlerforum.org)Kingston Hospital information sheet: A0213-Selective-eating-in-children.pdf (kingstonhospital.nhs.uk)Please see HCP referral page for more information click here
Autism without associated feeding difficulties	Autism Society: Eating – a guide for all audiences (autism.org.uk) NHS website: http://www.nhs.uk/livewell/autism/pages/parentsguidetoautism.aspx
Checking calcium adequacy	Kingston Hospital information sheet: Microsoft Word – A0180 Calcium Information Sheet (kingstonhospital.nhs.uk)
Mild – moderate constipation	See Kingston hospital information sheet: A0100-Constipation-in-children-2.pdf (kingstonhospital.nhs.uk) NHS website: http://www.nhs.uk/planners/birthtofive/pages/constipation.aspx ERIC website: https://www.eric.org.uk/advice-for-children-with-constipationBladder and Bowel UK website: Understanding-childhood-constipation-leaflet-advice-for-parents-and-carers.pdf (bbuk.org.uk)
General nutritional assessment / Nutritional analysis of food diary	Unfortunately, we do not have capacity to see these patients. The following link can be used if they would like to find a private Dietitian: Find a dietitian \| British Dietetic Association (BDA)
Eating Disorders (diagnosed anorexia nervosa, bulimia)	Please refer to relevant eating disorder service or to CAMHS NHS website: http://www.nhs.uk/conditions/eating-disorders/pages/introduction.aspxBEAT website: https://www.beateatingdisorders.org.uk/
Eczema – without associated food allergies or faltering growth	NICE 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/ Preventing food allergy guidance:BSACI website: Infant feeding and allergy prevention PARENTS FINAL (bsaci.org)Useful Australian website: https://preventallergies.org.au/healthcare-professionals/
Other suspected IgE mediated food allergies including Egg and Nut allergy	Allergy UK: Food Allergy \| Allergy UK \| National CharityNICE guidance: Overview \| Food allergy in under 19s: assessment and diagnosis \| Guidance \| NICEPatients can be referred to the allergy clinic at Kingston Hospital for assessment and management : Allergies in Children – Kingston Hospital
Food Challenges or allergy testing	Patients 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 another paediatric allergy service (not KH)	Please refer to the dietitians from the same service to provide continuity of care
Loose Stools (unless diagnosed with a nutritional cause e.g. Coeliac Disease, Cow’s Milk Protein Allergy, Lactose intolerance)	Bladder & Bowel UK: Understanding-Toddler-Diarrhoea.pdf (bbuk.org.uk)
Preterm babies Weaning	Bliss 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)	Kingston Hospital webpage: Gastro-Oesophageal Reflux in babies – Kingston HospitalNICE 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)	British Dietetic Association: Vegetarian, vegan and plant-based diet \| British Dietetic Association (BDA)Vegetarian society website Health and Nutrition \| The Vegetarian Society (vegsoc.org)
Weaning and eating well in early years	BDA website: https://www.bda.uk.com/resource/complementary-feeding-weaning.htmlNHS: Weaning and feeding – NHS (www.nhs.uk)
Weight Management/Healthy Eating	Kingston:HENRY programmes are running in Kingston for families with children 0-5 (Healthy Families Right From the Start) or with children 5-11 (Healthy Families Growing Up). For information please contact us at henry@yourhealthcare.org or to ask to join a free programme please complete the referral form HENRY referral form (Page 1 of 6) (office.com)Weight loss support for 16yo + in Kingston: Connected KingstonSEND 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#Richmond:The school nursing team run the Family Start weight management programme for children in reception to Year 13 that are overweight or obese. For more information or to self-refer contact them at: clcht.0-19wandsworthandrichmondadmin@nhs.netSurrey:Be Your Best family weight management programme for children aged 0-12 in Surrey: www.bybsurrey.org

Additional general information available for first line advice:

Kingston Hospital HCP webpages (Paediatrics):

Paediatric referrals (Healthcare Professionals)

Patient Information Leaflets section (Paediatrics): will support basic queries on constipation, eczema, Gastro-oesophageal reflux, cow’s milk protein allergy
Links to refer to various paediatric services- including allergies
https://kingstonhospital.nhs.uk/healthcare-professionals/paediatrics-referrals/allergies-in-children/

BDA (British Dietetics Association) Food Fact Sheets:

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/