Clinics and wards used by dietetics services
A dietetics service is currently offered to all the clinical specialities at Great Ormond Street Hospital (GOSH).
Surgery and Orthopaedics
Some of the common nutritional problems in this group of children may be:
increased energy and nutrient needs
impaired absorption of fat and other nutrients
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, Immunology and Bone Marrow Transplant (BMT)
Children with these conditions may become malnourished as a result of:
nausea or vomiting
diarrhoea or increased nutrient needs
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
Please see these information sheeta from theHaematology/Oncology dietitians:
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
Common problems seen in this group of children which affect their ability to eat and drink are:
difficulties with swallowing (dysphagia)
poor muscular control
Some children with epilepsy are offered the Ketogenic Diet as a treatment option. For more information, please see this link and this information sheet from the Ketogenic dietitians:
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
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:
cause symptoms of diarrhoea, constipation & reflux
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.
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.
Children with skin conditions such as severe eczema have a much higher risk of food allergies, due to the skin barrier being broken, and the allergens being able to get in and sensitise . The dietitian will help organise allergen free meals for these children and might review the child’s typical dietary intake to assess nutritional adequacy.
Children with Rheumatology conditions will often need steroids, either in the short term or long term management. A Dietitian will help to advise a healthy diet to help prevent too much weight gain, whilst still promoting good growth in childhood. Certain conditions might have other concerns such as a weak swallow during elements of the treatment, and may need an Nasogastric tube to help support nutritional intake for a short time.
Conditions that may be seen by a Dietitian include HIV, TB, Hep B. The dietitian will help to assess intake and requirements and nutritional adequacy, giving advice on ways to optimise this if needed, or alternatively giving advice on a healthy balanced lifestyle. Medication such a steroids may be included as part of the treatments in these conditions which can lead to an increase in appetite and subsequent weight gain. For long term health, maintaining a healthy weight and good activity levels are important.
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.
International and Private Outpatients
A dietetic service is provided to International and Private Outpatients.
We work closely with our consultants to provide appropriate nutrition and dietary advice for your child.