Clinics and wards

A dietetics service is currently offered to all the clinical specialities at Great Ormond Street Hospital (GOSH).

These include:

Our role within some of the specialty areas are described below:

Cystic Fibrosis

Some of the common nutritional problems in this group of children may be:

  • poor appetite

  • increased energy and nutrient needs

  • impaired absorption of fat and other nutrients 

The dietitian will aim to maximise growth by improving nutrient intake and optimising absorption through the use of enzyme replacement therapy. 

Intensive care

The dietitian will advise on appropriate methods of feeding your child while on intensive care. This may be in the form of a feeding tube (enteral nutrition) or intravenous feeding (parenteral nutrition). 

Haematology, Oncology and Bone Marrow Transplant (BMT)

Children with cancer may become malnourished as a result of:

  • poor appetite

  • nausea or vomiting 

  • diarrhoea or increased nutrient needs

This may be caused by the effects of the cancer itself or side effects of the treatment - chemotherapy, radiotherapy or surgery. 

The dietitian will aim to:

  • prevent or correct malnutrition

  • promote growth through the provision of nutrient dense snacks and drinks, or by means of enteral or parenteral nutrition

Children undergoing bone marrow transplant will often require nutritional support and 'clean' diets (prepared in our diet kitchen) to reduce the risk of infection post-transplant. 

Cardiology

Poor growth is common in infants with congenital heart disease. These infants will fail to complete feeds offered orally and this may be due to fatigue brought on by the effort of sucking, poor appetite or early satiety. 

The dietitian will aim to optimise nutrient intake by:

  • changing the pattern of feeding

  • manipulating the nutrient density of the diet

  • tube feeding

Neurology

Common problems seen in this group of children which affect their ability to eat and drink are:

  • difficulties with swallowing (dysphagia)

  • poor muscular control

  • developmental delay 

The dietitan will aim to identify those children who are at risk and advise on how to optimise nutrient intake to suit their needs and neurological function. 

Nephrology

The kidney is responsible for removal of wastes from the body so maintaining a good balance of fluids, electrolytes and minerals. 

Children with poor kidney function may require a strict fluid allowance and may require electrolyte restrictions to keep the balance of these in the blood acceptable (phosphate, sodium or potassium). 

They commonly have poor appetites and food intake so require input from the dietitian in order to:

  • optimise their energy and nutrient intake 

  • promote normal growth 

Gastroenterology

Infants and children seen by the gastroenterologists may have difficulties with gut motility (moving food through the gut properly) or may be unable to digest or absorb certain nutrients. This may result in:

  • poor growth

  • cause symptoms of diarrhoea, constipation & reflux

  • poor appetite

Manipulation of feeds and diet is often the primary treatment of the underlying condition. 

Surgery

There are a number of congenital abnormalities that require surgery in the neonatal period. These malformations affect the oesophagus, stomach, duodenum and the small and large intestine.

The dietitian will advise on an appropriate feed and method of feeding determined by the area of gut affected and the surgery performed to correct the defect. 

Metabolic medicine

Dietitians are involved in the treatment of infants and children with a wide range of Inherited Metabolic Disorders including problems with utilising specific amino acids, fats or carbohydrates.

Manipulation of the diet is an essential part of the treatment. The dietitian will provide ongoing dietetic support for the family throughout childhood and adolescence in the form of regular telephone contact and outpatient clinics. 

Epidermolysis bullosa (EB)

Children with severe forms of EB often grow poorly because of complications such as blistered mouth, painful swallowing and constipation. The dietitian advises on modified meals, specialised supplements and feeding via a gastrostomy tube.

Child and Adolescent Mental Health

The dietitian is involved in the multidisciplinary management of children with eating disorders and behaviour problems around feeding. They will advise about the nutritional adequacy of the diet and strategies to improve intake of food.