SERVICES FOR DISABLED CHILDREN AND THEIR FAMILIES – LOCAL OFFER
Name of Service:
Service Manager / Contact Person
Contact details
Can your child receive
support from the service?
(Eligibility criteria)
Dietetics
Debra Drazen
Address:
Beckenham Clinic
14 The Crescent
Beckenham
BR3 1DU
Tel: 020 8662 6681
E-mail: debra.drazen@nhs.net
BROMLEY HEALTHCARE CHILDREN’S DIETETIC SERVICE
REFERRAL CRITERIA
The Children’s Dietetic Service referral criteria are set out below. GPs and other health professionals can contact the
Children’s Community for further guidance before making a referral on 020 8662 6688.
Children need to have a Bromley G.P. to receive support from this service. If you think your child may benefit from a referral
according to the criteria below, please discuss this with your GP or other health care professionals working with your child
Referrals accepted:
Home Enteral
All children with nasogastric, gastrostomy or jejunostomy Tubes should be referred to the Children’s
Tube Feeding
Community Dietitians
Obesity
All children with BMI >98th centile, if the family is motivated to make lifestyle changes:
 Health Visitors, Nurses or Doctors provide first line advice and follow-up as per Bromley
Managing Obesity Algorithm and childhood obesity guidance.
 Referrals made to Paediatrician if comorbidities or other concerns
 Referrals accepted for further support
Faltering Growth
Any child who has crossed two or more centiles for weight, or where there is marked discrepancy
between height and weight centiles.
Please attach a copy of weight chart to referral.
Food allergies or
Any child who has to exclude major food groups from their diet because of allergy/intolerance should
intolerances
be referred to the Children’s Community Dietitians. Such exclusions include cows milk, egg, wheat or
which involve
soya.
food exclusion
Exclusions: If the child has a history of anaphylaxis or suspected risk of anaphylaxis (breathing
problems, swelling around mouth or throat, severe asthma, or any severe instant reaction) they
Specific
concerns that
nutritional intake
is inadequate
General concerns
that diet is
deficient
Constipation
Toddler
diarrhoea
Faddy eating/
fussy eating/
selective eating
Swallowing
problems
Advice on diet for
behaviour and
autism
should be referred to the Allergy Clinic at the PRUH.
Children with feeding problems due to physical feeding problems, developmental delay or medical
treatments (e.g. cancer therapies).
Refer to Children’s Community Dietitians for assessment, advice and follow-up.
Common concerns about diets are regarding iron and calcium intakes where dietary intake is limited
such as faddy eating, vegetarian/vegan diets:
1. Health Visitor/Nurse should give first line advice (available on CDS intranet).
2. Blood haemoglobin and ferritin test via GP and treatment if necessary
3. Refer to Children’s Community Dietitians if diet remains poor despite first line advice or concerns
regarding faltering growth (see above).
1. First line advice sheet is given by Health Visitor/Nurse
2. G.P. to refer to Constipation Clinic at Phoenix Centre
3. Refer to Children’s Community Dietitian only if further nutritional advice or assessment needed
e.g. faltering growth (see above)
Referrals not accepted unless there are concerns regarding faltering growth (see below).
An advice sheet is available via the CDS intranet for Health Visitor/Nurse
1. Health Visitor/Nurse provide first line advice and behavioral support Consider iron deficiency
(common in toddlers and decreases appetite further). Request haemoglobin and ferritin tests via
GP and treat as necessary.
2. Refer to Children’s Community Dietitians if further dietary advice or assessment needed e.g.
faltering growth (see above), autism
1. Refer for speech and language assessment for advice on safe intake
2. Refer to Children’s Community Dietitians if concerns regarding adequate nutritional intake
Advice on fish oils for ADHD, avoiding E-numbers for hyperactivity, special diets for autism:
1. Health professionals can provide first line written advice sheets written by the dietetics service
2. Referrals are only accepted if the child is already following an exclusion diet where assessment
or advice is needed to ensure adequate nutrition, or if concerns that excessive supplements are
being taken
Exclusions: the service is unable to accept referrals just to discuss whether these interventions are
worthwhile – this information is covered on the written advice sheets
Specialist nutritional problems not seen by us (unless on Home Enteral Tube Feed)
Allergy
If they are under a specialist hospital allergy clinic
Diabetes
Managed in consultant-led clinic at PRUH
Eating disorders
Such as Anorexia Nervosa/ Bulimia Nervosa  Refer to CAMHS Tier 3 – Oxleas for
assessment
Ketogenic diets for epilepsy
Cystic Fibrosis
TPN/ PN (parenteral nutrition)
Renal/ kidney disease
Liver disease
Managed by hospital dietitians where diet is initiated e.g. Evelina, GOSH
Managed by hospital dietitians in specialist centre
Managed by hospital dietitians and team where PN is initiated.
Managed by hospital dietitians in specialist centre
Managed by hospital dietitians in specialist centre
Children with a Bromley GP referred to the Children’s Dietetic Service (CDS) can be seen locally at Princes Plain Clinic,
Community Vision Clinic or St Paul’s Cray Clinic. Home enterally fed children may be seen at home.
How can your child be
referred to the Service?
Referrals accepted from GPs, health visitors and other health professionals, via Bromley Healthcare’s Single point of entry or
by using the child health referral form
How to complain about
anything related to the
service you receive for
your child?
We want you to be happy with the service you receive from us, but we know that every so often something might go wrong or
could be improved. If you're unhappy with the care you receive or an element of our service, we want to hear from you. This
is important to us so we can continuously improve our services
Please speak to your clinician in the first instance or Head of service if you prefer, details above. If they are unable to resolve
your concerns or you would like to take the matter further please contact us at the address below.
Global House
10 Station Square
Hayes
Bromley BR2 7EH
contact@bromleyhealthcare-cic.nhs.uk
www.bromleyhealthcare.org.uk
Please see the attached for more information on how to give your feedback to us about your experience
LI0269 - Feedback
Leaflet.pdf
Of course, we also want to hear from you if you're happy with the care you're receiving - it's good to be able to thank the team
and let people know they're doing a good job, so if you have a compliment or congratulation, we'd like to hear from you.
We are also encouraging people who use our services to write a review on Patient Opinion of their
experience. All postings are anonymous and feedback allows us to improve the services we provide.
www.patientopinion.org.uk
UNIVERSAL
TARGETED
SPECIALIST
This means the support from the
Service that is available to ALL
children in mainstream preschool/schools
This means the Children’s Service
is available for individuals or small
groups who are considered to
require additional support.
This means the support available
to your child through a specialist
package of care, such as an
Education, Health and Care Plan.
In Mainstream Schools:
This input may involve individual
support and is typically medium /
longer term intervention
Where necessary for the clinical
management of a child,
advice/training is available for
teachers and other staff
Learning / curriculum support
This is the support from the service,
available for teachers and other staff
members to adapt the curriculum and
environment to make sure your child
makes the best possible progress in
school.
N/A
N/A
In Special schools:
N/A
Physical and emotional well-being
Specific first line advice sheets
are provided for health
professionals to use, for example,
information for paediatric
conditions such as constipation
and toddler diarrhoea
Where necessary for the clinical
management of a child,
advice/training is available for
teachers and other staff
N/A
This will be considered when
developing a care plan with the
family
Access and inclusion resources
N/A
N/A
N/A
School based training
N/A
N/A
Training is provided to schools where
required for the clinical management
of the child to support their nutritional
and dietetic needs
Support for families:
N/A
N/A
The parents of children referred to
the service who meet the referral
criteria are supported to meet their
child’s nutritional and dietetic needs
as appropriate
Therapeutic Approaches
N/A
N/A
N/A