Community Paediatric Service 558 referrals received from Luton

Community Paediatric Service 558 referrals received from Luton GP’s/ Health Visitors/ School Nursing in 2016. Specialities include –allergy, faltering growth, obesity (under 5 yrs), vitamin & mineral deficiencies, learning disabilities/ restrictive diets. Deliver 7 x community clinics per month and manage a caseload of tube fed infants and children across South Bedfordshire and Luton.

Food hypersensitivity Is a reproducible sign or symptom which is produced after Food Hypersensitivity WAO (2010) 1. 9 -4. 9% of children consuming a certainestimates type of food. suffer with cow’s milk protein allergy. Cow’s milk allergy may be defined as a reproducible adverse Perceived couldmediated be up toby 10 one times reaction to one orfood moreallergy milk proteins or more immune mechanisms. higher. Food intolerance Food allergy Ig. E mediated Non-Ig. E mediated

CMPA treatment - formula fed Follow prescribing guidelines: Summarised ndline Neocate LCP (from birth) –&AAF 321 strd line–––Similac Aptamil. Alimentum Pepti 1 – EHF (<6 m) or 2 (>6 m) 2 line (<6 m) Nutramigen Usually started in accepting specialist or first secondary care. to taste. Use if–infant not line due (>6 m) EHF If severe/multiple allergy. Whey Caseindominant. If symptoms not resolved with EHF. Contains some lactose.

Soya formula/ alternatives Not recommended for infants less than 6 months of age due to phytoestrogen in soya formula. There is a risk of co-existing soya and cow’s milk allergy Infant over 6 months could be prescribed if EHF refused. Soya yogurts/deserts are suitable as alternatives over 6 months of age.

What is lactose intolerance (LI)? Lactose is the sugar in milk and dairy products. LI occurs when lactose not absorbed in gut. Symptoms are lower gut related: abdominal pain, bloating, increased wind, loose green stools. Primary LI does not usually present until later childhood or adulthood. Secondary LI occurs post gut trauma – usually resolves on its own.

Taste Testing Similac Alimentum Nutramigen LGG 2 Neocate LCP

Gastro oesophageal reflux disease GOR – normal process, very common – provide reassurance to parents. GORD – reflux of gastric contents causes severe symptoms that warrant medical treatment. Thickened formulas should only be used as part of stepped care approach – NICE guideline 1 (NG 1). Over the Counter OTC use first line: Cow & Gate or Aptamil Anti-reflux OR SMA staydown. Thickened formula to use first line if a prescription is required: Enfamil AR (to be used for those with ongoing reflux concerns).

Specialist Infant Formulas – Pre term Pre-term formula’s Nutriprem 2 powder (900 g tin) or SMA Gold prem 2 powder (400 g tin) Use until 3 -6 months corrected age Corrected age = gestational age-number of weeks premature Remember: Children born 32 -36 weeks –correct until 1 year Children born very pre-term (<32 weeks) corrected until 2 years Ensure that there is an end date for prescription

Oral Nutritional Supplements – Paediatrics Paediatric super shakes (homemade recipes) Fortini/Fortini Multifibre (1. 5 kcal/ml) Fortini Smoothie multifibre (1. 5 kcal/ml) Fortini 1. 0 multifibre Calogen FP 10 -disease related malnutrition, growth failure

Gluten Free Products

Thank you for listening Any questions?

References Food first- http: //www. sept. nhs. uk/our-services/bedfordshire-andluton/bedfordshire-community-health-services/adults/nutritiondietetics/food-first/ Food First Team (SEPT) South Bedfordshire Food. First@nhs. net Telephone: 01582 707 629, Fax 01582 521 191 BAPEN- http: //www. bapen. org. uk/ National Institute for Health and Clinical Excellence (NICE) http: //www. nice. org. uk/guidance/cg 32/resources/guidance-nutritionsupport-in-adults-pdf NHS Choices- http: //www. nhs. uk/pages/home. aspx