The Children's Dietetic team see children from birth to 18 years of age with a varying range of conditions, including diabetes, food allergies (including cows' milk allergy), and medical conditions requiring diet therapy.
We see inpatients on Dolphin High Dependency Unit, Dolphin Ward, Puffin Ward, Sunflower Ward and the Neonatal Unit at Royal Derby Hospital. We also run regular outpatient clinics at the Children's Hospital and telephone clinics. A service is also funded for children attending Bladon House School.
Children we see
We see children from birth to 18 years of age with a varying range of conditions. For example;
- food allergy (including cows' milk allergy)
- faltering growth
- premature babies
- children needing tube feeding
- ketogenic diet for epilepsy
- cystic fibrosis
- coeliac disease
- neuro disability
- Prader Willi Syndrome
- other medical conditions requiring diet therapy such as cardiac, renal and liver impairment
We are acute dietitians and therefore only take referrals for children under the care of a Derbyshire Children's Hospital consultant. The exceptions are children attending Bladon House, where we will accept referrals for residential students under a Derbyshire GP, and infants under 1 years with a diagnosed cows' milk allergy. These infants can be referred directly by the GP using the agreed Derbyshire CCG pathway.
If you feel your child needs to see a dietitian please ask your hospital paediatrician. If they are not under a paediatrician please see your GP for advice.
Telephone: 01332 785233
Below you will find general information to help with children’s nutritional needs and some common difficulties we come across. If you are concerned about whether this is appropriate for your child speak with your dietitian, GP, health visitor or paediatrician.
Cows' milk allergy
Cows' milk protein allergy (CMPA) is very common in childhood. Most infants and children that get this diagnosis will outgrow it by the time they are 5 years old.
Following a diagnosis, your health care provider can give you basic advice on how to manage your infant or child’s allergy. Health care professionals or parents/carers can use the digital milk free information pack below to refer to learn how to follow a milk free diet, and how to re-introduce it back into an infant or child’s diet.
Occasionally, a patient that is diagnosed with CMPA is also allergic to soya. We have included the soya reintroduction ladder too.
Please look carefully at the frequently asked questions in the information packs below, which will help guide the management of the allergy.
If at any point your child is demonstrating signs of faltering growth (crossing down 1 or more centiles in their red book) or the diagnosis and treatment that follows is not correcting the original symptom, please go back to the Consultant or GP who referred you for additional support and advice.
Milk free information packs
Please find resources below to guide you through following a milk free diet successfully and re-introducing milk into the diet when appropriate.
- Download Cow milk allergy - guide for parent carer [pdf] 116KB (opens in new window) >
- Download Cow milk allergy - guide for HCP [pdf] 242KB (opens in new window) >
Patient information leaflets
There are also some useful resources available on the following websites:
- Access Allergy UK website for General cow's milk allergy information including travel advise and suitable milk alternatives (opens in new window) >
- Access Allergy UK website for information on weaning with allergies (opens in new window) >
- Access BDA website for milk allergy food fact sheet (opens in new window) >
- Access NHS patient webinar series on Cow's milk protein allergy (opens in new window) >
Children require a varied and balanced diet to ensure they receive all the necessary nutrients for good growth and health. As they grow their nutritional needs may change slightly but a routine of regular meals and snacks will always be essential. Healthy eating means food from the four main food groups should be offered daily, these groups are;
- Bread, rice potatoes and other starchy foods
- Fruit and vegetables
- Milk and dairy foods
- Meat, fish, eggs and other non-dairy sources of protein
Food and drink high in fat and/or sugar such as biscuits, crisps, cakes, fried foods and sugary drinks are high in energy but low in other beneficial nutrients. These foods should only be offered occasionally as a treat. Salty foods such as processed items and ready meals should also be limited, do not add any salt to children’s foods, use herbs and spices for flavour instead.
The healthy options for drinks are water or milk. If you choose to offer your child any sweet drinks, including fruit juice or squash, they should be diluted with water and offered at mealtimes only.
The Department of Health recommends that all children aged 6 months to 5 years are given vitamin supplements containing vitamins A, C and D every day.
Packed lunches are a great way to ensure your child has a healthy meal to hand whether it is for a school day or day out.
They can also be useful if your child has any food allergies or intolerances as you can ensure the content is appropriate for their diet. When making a packed lunch ensure it contains healthy options (see information on healthy eating section). Some schools have specific guidelines on what should or shouldn’t be included in a packed lunch so please stick to these whilst keeping the packed lunch varied. Be sure to keep the packed lunch cool in a fridge or cool box/bag to help make it more palatable for your child.
Portion sizes for children vary dependent on their age, here are a few top tips to help you to incorporate a healthy eating pattern at home;
- Use a child friendly plate to avoid feeding your child oversized adult meals.
- Incorporate a general healthy eating pattern (as like any adult) and be mindful that their portion will differ to that of an adult. Some good resources to outline portion sizes for children can be found below.
Fussy eating and food refusal is a phase that most children pass through. It is common for children to refuse foods that are new to them, but it is equally important that you persist with offering it them again as they often need to experience tastes repeatedly to learn to like them.
Children also refuse food if they are full or have eaten enough. Children of similar ages vary in the quantity of food they eat due to the differences in rate of development. If your child is growing and developing normally then try to be reassured that they are eating the right amount of food for their needs.
Remember the amount of food children eat may change day-to-day. It is often very stressful for parents when their child is refusing food. It is important to try not to become too anxious around meal times, as your child will be very quick to pick up on this and their intake may reduce further.
Top tips for fussy eaters
- Plan meals and snacks ahead of time - try a meal plan so they know what to expect.
- Limit meal times to 30 minutes - Leaving the food in front of them for longer than this period won’t often result in more being eaten.
- Reward charts can be helpful - Praise good behaviour with regards to food, ignore bad behaviour.
- Introduce new foods with foods the child already likes. Always try and include something on the plate that you know your child will eat.
- Eat in a calm and relaxed environment e.g. at the table as a family. Try not to use distractions such as TV, games and toys.
- Eat with your child as much as possible. Children learn by copying their parents and other children.
- If a meal is refused don’t offer a replacement or snack immediately after. Stick to your meal plan otherwise the child will soon take advantage of this.
- Involve the children in the cooking of the food and preparation. This may introduce them to new foods that they might not necessarily.
Despite fussy eating usually being just a phase, if the problem persists or you have concerns speak with your GP, health visitor or paediatrician. Below are some helpful websites and information to help with overcoming this phase.
Generally, the process of introducing a baby to solid foods should start around the age of 6 months. Waiting until this age ensures that babies have had time to start developing the skills needed to move food around their mouth and to swallow it. This may mean that they will be able to progress onto a range of tastes and textures more quickly. There are three key signs which, in combination, show that your baby is ready for weaning. These are;
- being able to sit up and hold their head steady.
- being able to co-ordinate their eyes, hands and mouth, so that they can look at the food, pick it up and put it in their mouth independently.
- being able to swallow food, rather than spitting it back out.
If your baby was born prematurely, ask your health visitor or GP for advice on when is the best time to start introducing solid food.
At first, weaning is about getting your baby used to new tastes and textures and developing eating skills, rather than getting a lot of nutrition from food. At this time they will still be getting most of their energy and nutrients from breast milk or formula. As time goes by you can increase the amount, texture and variety of food your baby eats and by the time they are 1 year of age, most children will be eating chopped or mashed family meals.
Some useful sources of information about weaning are listed below;
Weight management services for children
Becoming overweight and obese is a more widespread problem for children and teenagers in today’s society. Simply put, weight gain is caused by energy intake being higher than energy expenditure, however losing weight is often more complicated and difficult than we think.
A lot of children have an unhealthy diet and easy access to foods higher in fat and sugar, this combined with the lack of exercise, contributes to on-going weight gain.
The Children's Dietetic service at Derbyshire Children’s Hospital is able to accept referrals for overweight and obese children from a paediatrician at the hospital if they have additional co-morbidities as a result of their weight. GP’s are not currently able to refer children directly to our service for weight management advice.
If you would like some additional advice and support with regards to weight management you can self-refer to some community services within your local area. They are outlined below;
- Visit the Live Well Derby website (opens in new window) >
- Visit the Live Life Better Derbyshire website (opens in new window) >
Please ensure that you live within their catchment areas, this information can be found on their website.
If you are continuing to struggle with your child’s weight or obesity, please seek additional support from your GP as they may be able to redirect to other local services. In the meantime, here are a number of useful websites with information about healthy eating and exercise recommendations for children;