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Specialist Feeding Clinics 153
the child is not eating adequately then a vitamin to eat. Often the appetite is suppressed and so strict
and mineral supplement can be given to cover any healthy eating guidelines should be put aside until
low intakes of specific nutrients until the child the child is gaining weight and has an improved
widens their intake of food. appetite.
If growth is faltering then a child needs to be Increasing fat intake using oil, butter, cream and
referred to a paediatrician for assessment. Referral mayonnaise are the most effective ways of
to a specialist feeding team may be possible where increasing calories:
a multidisciplinary team can support parents to
manage the feeding problem. ●● Foods can be roasted or fried in butter or oil
rather than grilled, steamed or boiled.
A very small number of children do not grow
out of this phase and continue to restrict the foods ●● Butter or oil can be added or mixed into hot
they eat throughout their childhood years. If they foods such as pasta, rice, vegetables and mashed
eat enough of their preferred foods to meet their potatoes.
energy requirements and take a vitamin and
mineral supplement to address any deficiencies, ●● Mayonnaise can be added to dishes in larger
they will grow and develop normally despite a very quantities.
restricted diet.
●● Butter and margarine can be spread more
Faltering Growth thickly on bread or crackers.
When children do not eat enough their growth may ●● Cream can be added to puddings, fruit and
falter. This is defined as weight or height crossing breakfast cereals.
down through 2 centile spaces on a growth chart.
Increasing carbohydrate is usually most effective
Causes of faltering growth are: by adding extra sugar to cold foods, drinks,
puddings and breakfast cereals.
●● malnutrition through not eating enough food
If children enjoy high-calorie foods such as
●● diseases involving malabsorption or decreased cheese, peanut butter, fatty meats, cakes and
appetite biscuits, these can be offered more frequently and
in larger portions.
●● hormonal syndromes (e.g. hypothyroidism,
Turner syndrome, growth hormone insufficiency) Powdered supplements for adding to food and
supplement drinks are available on prescription
●● physical or emotional neglect. but should only be used as a second choice and with
medical and dietetic supervision. They are an
Most faltering growth in children 1–4 years old is expensive item for GPs’ budgets and their use and
due to poor eating. Only 5 per cent is due to disease effectiveness needs to be carefully monitored to
or hormonal disorders. It is estimated that a further justify the cost.
5 per cent is due to neglect and will need the
support of those involved in child protection. If improving mealtime management and
increasing the calorie content of foods is not
If faltering growth is due to fussy faddy eating as successful in restoring normal growth velocity
described above then the first aim should be to then the child should be referred to a paediatrician
agree a strategy for managing meal and snacktimes and on to a specialist feeding clinic.
so that the child does not become anxious around
mealtimes and is allowed to decide what and how Specialist Feeding Clinics
much they eat.
Children whose health may be compromised by
The second aim is to increase calorie intake and their eating behaviour may be referred to a feeding
this is best achieved by increasing the calorie clinic if one exists in their NHS area. Such clinics
content of foods and meals that the child is happy provide a coordinated multidisciplinary approach
