Feeding to thrive service seminar march 9 th 2012
1 / 33


  • Uploaded on
  • Presentation posted in: General

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

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.

Download Presentation


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


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

  • A multi – disciplinary working party

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.

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 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

  • 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...........................

  • Organic disease which is accompanied by environmental factors

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

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 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

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

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

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


  • 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]


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

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

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:


    Speech & Language Therapist

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

  • 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


  • 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

  • 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


  • Address maternal anxiety /attachment

  • Consultant Community Paediatrician

  • Triple P

  • EYV

  • Spec NN

  • School dinners

Further review


  • Support mother with continued reassurance

  • Increased independance/enjoyed school

  • GP / hospital visits reduced

  • Weight 0.4 - 2nd

Case history 2

  • Child aged 5 months

  • 0.4 centile

  • LAC

  • Feeding difficulties/inconsistent management

  • GOR


  • 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

  • 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

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

  • Feeding behaviours remained erratic

  • Maintenance of SpNN involvement


  • 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...

  • Adoption placement

  • Transition period important

  • Consistent management

  • Successful adoption placement

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



  • 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

  • Login