Health services for children and young people

A Dietitian (or Dietitian) is an expert in food and nutrition. Dietitians give dietary advice, help promote healthy eating habits, and develop specific diets for people.

The types of work they do can be different when they are working with children and adults. Dietitians are the only qualified health professionals that assess, diagnose and treat diet and nutrition-related problems.

Paediatric (children’s) dietitians specifically deal with children and their nutritional needs to support their health and growth. Your child may be referred to a dietitian by their Health Visitor or School Nurse. The types of needs a dietitian may treat include:

• Obesity or food refusal
• A significantly restricted diet that is affecting a child’s weight and growth
• Constipation or other digestive issues that may be caused by food

Your child may also be referred if they have:

• Physical disabilities that affect their swallowing and mean their diet needs to be modified
• If they have a metabolic disorder that means they cannot eat certain foods.

If you're worried about your child’s feeding and eating

Concerns about a child’s eating and feeding can begin very early when trying to breastfeed or when trying to wean your child to solid food.

If you are worried always discuss your concerns with your child’s GP school nurse or health visitor. If your child is under 5 you can also contact the HENRY team for advice on healthy eating and weaning. You can also call 0208 496 5223 to find out more or visit the Henry website.

Your child may be referred to a dietitian for further advice

Community Paediatricians, GPs, and health care professionals such as health visitors or school nurses may make referrals. You can ask for a referral to be made if you are concerned about your child’s diet and the impact on their weight, growth health, and energy levels.

If your child has been referred to a Community Dietitian

Children may be referred to the dietitian if:

• They are not weaning or gaining weight as expected
• Are highly selective about what they eat
• Have allergies
• Are significantly overweight

If your child is not gaining weight, or growing as you had expected compared to their original growth charts, you may be referred to the dietitian.

The dietitians will advise children and their families on how to manage dietary changes in a practical manner. They do this by using motivational interviewing and behaviour change techniques. We advise on the most suitable dietary products to manage clinical conditions, this may include:

• gluten free products
• alternative milk for cow's milk allergy
• nutritional supplements.

The dietitians have been trained to meet the needs of children who are selective eaters. This includes children that may have strong sensory preferences that limit the range of food that they eat.

They offer face to face consultations, telephone reviews and group education sessions. These sessions are fun and interactive, engaging children with age appropriate activities such as supermarket tours.

If your child has sensory needs you may be offered advice or a group called ‘messy munch’. The group aims to extend the range of foods your child will tolerate in a safe way, through play and exploring.

Referrals are accepted from consultants, GP practices, and qualified healthcare professionals. Referral form faxed or posted directly to the service. Also by telephone and email to nem-tr.walthamforestdietitians.nhs.net

Visit the Community Dietitian page to access the referral form.

If your child is in hospital or has a more severe dietary need due to a disorder that affects their metabolism your child may be seen by one of the dietitians based at a local hospital.  Specialist clinics in conjunction with consultants are run for allergy, morbid obesity, cystic fibrosis, diabetes and gastroenterology.

Find out more about Hospital Dietitians

Children aged 2 years old and under often put non-food items in their mouths as a normal part of exploration. In most cases, anything swallowed by accident will come out in their faeces and does not need to be worried about. This could include non-food items such as sand or play dough.

If a child swallows a magnet or anything metallic, they should be taken to accident and emergency immediately. This can cause a blockage in their bowel.

Usually, children will usually gradually grow out of the phase of eating non-foods. In some children, this can continue for a long time or is happening on a frequent basis.

In children who are very underweight or deficient in iron, eating non-foods or ‘Pica’ can be common. This is because the child’s body is trying to correct the vitamin deficiency. In most cases, the pica will resolve or lessen with vitamin drops.

For some children, the pattern of eating non-foods can become fixed. In these cases, a behaviour plan may be needed. This involves identifying when a child is likely to eat non-foods and distracting or diverting them.

If you are concerned about your child eating non-foods, contact your health visitor or school nurse who can discuss with you if an onward referral is needed.

You can read more about pica on the beat eating disorders website.

People may also be thought of as ‘Selective Eaters’ where there are foods they don’t eat because of texture, smell, or taste. This type of selective eating only becomes an issue if it causes secondary health problems such as poor weight gain, lack of vitamins, or obesity.

If your child's eating choices are severely affecting their development this may be referred to as  (ARFID). It exists in children who were called ‘fussy eaters’ and it also exists in adults in various forms.

If you or your child are selective about what you eat you might want to find out more about Avoidant Restrictive Food Intake Disorder

Eating Disorders: children and adults services

An eating disorder is specifically eating disturbances that are motivated by the need to control weight and shape.

If you're concerned that you, your child, or a young person may be developing an eating disorder you may be referred to one of the specialist eating disorder services

Fussy and faddy eating

If you are concerned about your child’s eating, if they are fussy or refusing foods (selective) the Infant Toddler Forum is a really great source of advice.

Allergies

The food facts sheet from The British Dietetic Association is about cow’s milk allergy.

The Allergy Service also provides lots of useful information on allergies in children for parents, families and professionals.

General healthy eating guidance

The food facts sheet from The British Dietetic Association is about general healthy eating for children

The Caroline Walker Trust produces nutrition guides for all ages. These can be used by parents, families, and young people as well as schools and other institutes providing food. These include brilliant portion guides, recipes, and meal ideas.

First Steps Nutrition is an independent public health nutrition charity that provides information and resources to support eating well from pre-conception to five years. There are healthy eating guides, information on food banks, recipes and ideas as well as a guide to vegan diets in the under 5's

Specific vitamins and minerals

The below 'food facts' sheet from The British Dietetic Association provides information on:

• Vitamin D
• Iron
• Calcium

Constipation

Constipation is common in childhood and small changes to diet and fluid intake can improve bowel habit. The NHS website has information on constipation and how to manage this in children. It is also recommended you visit the GP so that they can provide additional advice and any treatment required.

Weight management

Are you worried about your weight or your child's weight? If you know your weight and height, use the NHS Choices handy BMI calculator to find out if you have healthy weight.

If your child is underweight or has lost weight recently you may choose to visit your GP to ask for a dietitian referral.

If you or your child are overweight you could ask your GP if there is a local weight management service that they could refer you to.

There are some useful online resources:

• NHS weight loss plan
• Tips if your child is overweight
• Change for Life provides tips and resources for improving your families diet and activity.

Advice and support on eating and drinking difficulties for children and young people with SEND in Waltham Forest

The adults and children’s services can be contacted on:

Nutrition and dietetic service
Chingford Health Centre
109 York Road
Waltham Forest
London
E4 8LF

Contact the team by calling 0208 430 8090 or by fa on 0208 430 8091.
Email the Nutrition and dietetic service team
Single point of access referrals 

Opening times are Monday to Friday, 9am to 5pm.