Feeding to thrive service seminar march 9 th 2012
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FEEDING TO THRIVE SERVICE SEMINAR MARCH 9 th 2012. In the beginning. History of Feeding To Thrive Service. In 1999 a Part 8 child death enquiry where faltering growth was identified. No effective systems for management of faltering growth were identified. Audit

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FEEDING TO THRIVE SERVICE SEMINAR MARCH 9 th 2012

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Feeding to thrive service seminar march 9 th 2012

FEEDING TO THRIVE SERVICESEMINARMARCH 9th 2012


In the beginning

In the beginning..........


History of feeding to thrive service

History of Feeding To Thrive Service

  • In 1999 a Part 8 child death enquiry where faltering growth was identified.

  • No effective systems for management of faltering growth were identified.

  • Audit

  • A multi – disciplinary working party


Aims and purpose of service

Aims and purpose of service

To support services involved with children in Brighton and Hove aged 0-5 years with significant or persistent faltering growth and /or feeding difficulties.


Feeding to thrive service seminar march 9 th 2012

Children with faltering growth do better when supported in the community by their own health visitor with input from a multi-disciplinary team.

[Parkin Project, 1995]


The challenges

The challenges..........


The following criteria should trigger concern

The following criteria should trigger concern

WHO charts

  • weight fall through 2 or more centile spaces

  • Thrive Lines show faltering growth in term infants under 12 months of age

  • measurements below 0.4 centile

  • BMI below the 2ndcentile[over 2 years]

  • Children outside predicted adult height

  • www.rcpch.ac.uk/growthcharts


Uk 1990 charts children born before september 2009

UK 1990 charts - children born before September 2009

  • weight fall through 2 or more centile spaces

  • Weight and height over 2 centile spaces apart

  • Target centile range outside mid parental height by more than one centile at 3 years


And also

And also...........................

  • Organic disease which is accompanied by environmental factors

  • Significant behavioural feeding difficulties [not necessarily with faltering growth]


Feeding to thrive service seminar march 9 th 2012

Pathway for intervention processes and management of faltering growth and/or feeding difficulties in the community

Access to FTT service via the family HV

  • Paediatric Liaison Specialist Nurse discussion and advice

  • HV referral to Specialist Nursery Nurse for assessment.

  • HV/GP liaison

  • Symptomatic - GP referral to hospital paediatrician

  • Developmental delay referral to Child Development Centre.

  • Asymptomatic and no progress – referral to hospital paediatrician


Pathway for intervention processes for children attending the outpatient department

Pathway for intervention processes for children attending the outpatient department

Pathway advising links between Paediatrician or dietician with GP, HV and Feeding To Thrive service for assessment in the community


Intervention processes for children admitted to hospital to exclude organic disease

Intervention processes for children admitted to hospital to exclude organic disease

Pathway advising management whilst in hospital and links between hospital, community staff and the Feeding to Thrive Service for assessment on discharge


Specialist nursery nurse

Specialist Nursery Nurse

HV referral for a FTT assessment in the family home

Discussion with the family HV and joint

initial visit to set up package of care.

Family HV takes clinical responsibility throughout period of intervention


Aim of ftt assessment

Aim of FTT assessment

To facilitate collection of detailed information

  • identify causes

  • guidance to professionals and families

  • ensure the appropriate advice and support are given


Feeding to thrive assessment pack

Feeding to Thrive assessment pack

CONTENTS

  • Initial assessment / introduction

  • Questionnaire for parents

  • Eating and drinking diary

  • Feeding history

  • Frequently eaten foods chart

  • Observation of a meal

    Attached by HV:

    centile chart

    Thrive lines [up to one year]

    NFER


Interpretation of findings

Interpretation of findings

  • HV and Specialist Nursery Nurse discuss findings and plan further period of support with family

  • Difficulties often resolve at this stage due to increased parental awareness of mealtime management and nutritional requirements

  • Referrals


Referral for ftt team consultation

Referral for FTT team consultation

may become necessary for more specialist advice if difficulties do not resolve at primary care level or complex case requires earlier discussion


The feeding to thrive team

The Feeding To Thrive team

This is a multidisciplinary team comprising of:

  • Consultant Community Paediatrician

  • Paediatric Liaison Specialist Nurse

  • Specialist Community Nursery nurse

  • Family Support Worker [CAMHS]

  • Social Worker

    In advisory capacity:

    Dietitian

    Speech & Language Therapist


Feeding to thrive team meeting

Feeding To Thrive Team meeting

Multidisciplinary team meeting (professionals only): HV, GP, SW, Paediatrician and others involved invited.

Information shared, recommendations made, team care plan, review date set.


Case history 1

Case history 1

  • Child aged 2 years

  • Petite child

  • 0.4 centile

  • Asian family

  • Late weaning followed by poor appetite

  • Known to Paediatrician and dietician

  • No organic illness


Feeding to thrive service seminar march 9 th 2012

Cont.........

  • Referral to Spec NN

  • FTT assessment

  • Grazing through day. Milk ++

  • No mealtime structure

  • Advice given mealtime management, high calorie foods and reduction of milk consumption

  • Feeding improved and calorie intake increased

  • Discharged to HV service


Re referred a year later

Re-referred a year later

  • 0.4 centile

  • Maternal anxiety / attachment

  • Frequent attendances at GP / hosp

  • FTT assessment and support

  • Small appetite and food refusal

  • Perplexing case

  • Not resolving


Reviewed at ftt team level

Reviewed at FTT team level

Recommendations:

  • Address maternal anxiety /attachment

  • Consultant Community Paediatrician

  • Triple P

  • EYV

  • Spec NN

  • School dinners


Further review

Further review

Recommendations:

  • Support mother with continued reassurance

  • Increased independance/enjoyed school

  • GP / hospital visits reduced

  • Weight 0.4 - 2nd


Case history 2

Case history 2

  • Child aged 5 months

  • 0.4 centile

  • LAC

  • Feeding difficulties/inconsistent management

  • GOR


Feeding to thrive service seminar march 9 th 2012

Cont................

  • Hospital admission – at 6 months age

  • Concerns re weight < 0.4 centile

  • Feeding difficulties

  • FTT pathway

  • No organic cause other than GOR

  • Dietetic /SALT review

  • NG tube necessary

  • Discharged into foster placement /FTT service


Ftt assessment and support

FTT assessment and support

  • Erratic feeding behaviours

  • Support and advise foster parents in positive

    feeding management

  • Promotion oral feeding / 3 meals day

  • Gradual weaning off NG tube


Ftt team meetings

FTT team meetings

  • Working with HV, SW, GP, dietician and Paediatrician

  • Feeding behaviours remained erratic

  • Maintenance of SpNN involvement


Feeding to thrive service seminar march 9 th 2012

Cont............

  • NG tube out at 13 months age

  • Mealtimes less stressful

  • Wide variety tastes / textures

  • 20 months eating independantly

  • 0.4 – 2nd centile

  • Appetite variable [normal toddler patterns]

  • Maintain consistent mealtime management


And finally

And finally...

  • Adoption placement

  • Transition period important

  • Consistent management

  • Successful adoption placement

  • Continued review by HV, GP, SW and FTT team


Feeding to thrive service seminar march 9 th 2012

!


Brighton and hove children and families services guidelines

BRIGHTON AND HOVE CHILDREN AND FAMILIES SERVICES GUIDELINES

  • The management of faltering growth and/or feeding difficulties in children aged 0-5 years by the health visitor in the community in Brighton and Hove

  • Assessment of children aged 0-5years with feeding difficulties and/or feeding difficulties by the Specialist Community Nursery Nurse, Feeding To Thrive Service

  • Factors to consider when assessing behavioural feeding difficulties in children 0-5 years and planning management interventions

  • Available on the Pulse and RACH website


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