Refer a Patient to the Feeding and Eating Disorders Service

We would take referrals when a child/young person has been assessed by, and received intervention from, professionals at primary and secondary care level.

Intervention at primary care level typically includes GP input, health visitor, school nurses or dietetic assessment and monitoring.

Intervention at secondary care level, which must have been accessed before referring to us, might include a range of professionals depending on the child/young person’s needs, including Paediatrician, SLT, OT or CAMHS input where feeding and eating difficulties are understood to have a psychological and/or relational cause.

Where issues have not resolved following primary and secondary care input, we would welcome a referral into our service. For example, if following intervention at primary and secondary level the feeding or eating difficulties still have a medical impact on the child/young person, a referral to us would be appropriate. If the intake of food with supplementation means that the child/young person is at a safe and sustainable level for growth and development, then a referral to our service may not be accepted.

We welcome referrals from NHS Paediatricians, and CAMHS Clinicians. We are unable to accept GP, private, or self-referrals or referrals from Dietetics.

• Because we use a shared care model and are unable to provide acute or urgent monitoring and management, we require that the child remains open to the appropriate local professionals/services, such as a Paediatrician, CAMHS, or dietician. For example, we will require local dietetic monitoring of young people referred to, and under the care of, our service.
• For children suffering from co-morbid mental health issues, it will be necessary for local CAMHS to be in agreement with the referral and be part of the care package around the child, such as to provide adequate local intervention to treat mental health needs and to provide risk management during our intervention. Where a child is on a waiting list, we will consider whether assessment and/or intervention from our service is likely to be of clinical benefit prior to co-morbid mental health needs being treated;
• For children where there are medical concerns, we require that the child remains open to their local Paediatrician or Eating Disorder service and are being regularly reviewed for the health concerns/low weight, for example, children with a W4H of <80%.
• For children with co-morbid medical conditions, we require that the child is open to their local Paediatrician and are regularly monitored for these conditions. Co-morbid medical conditions (eg vomiting, constipation, reflux) must be investigated and/or managed prior to the referral;
• The absence of local provision or long waiting times to access interventions that would have been recommended at secondary care level will not be considered sufficient reasons to refer to a tertiary national feeding and eating disorders service.

To ensure the safety of the child and the efficacy of our intervention, we will need to ensure that the professionals listed above are working with the child/young person prior to commencing any work and continue as part of the package of care.

We consider referrals for children and young people who have a significant restricted food intake for various reasons, including:

• fear of weight gain
• concerns about body image, weight, and/or shape
• specific fears (eg vomiting, choking) impacting eating
• sensory sensitivities
• a lack of interest in food and/or eating

We also consider referrals for children who have eating difficulties in the context of:

• Comorbid mental health or neurodevelopmental conditions (eg anxiety, ASD, ADHD).
• Comorbid medical conditions or complex medical histories, in which physical symptoms have been ruled out as the primary cause for the eating disturbance, and are currently well managed.

In these instances, we carefully consider whether the severity of the eating disturbance exceeds that routinely associated with the comorbid condition.

We also consider referrals for children who are dependent on enteral feeding (eg nasogastric tubes) or nutritional supplement dependent.

When we accept a referral, we will offer either:

• professional consultation: to support local service input and provide advice, recommendations and support to local teams
• second opinions where there are issues around diagnostic uncertainty,
• assessment of the child and family

Following the assessment, we will provide advice and recommendations to the family and to primary and secondary care professionals involved in the child’s care. This might consist of a monitoring plan, suggested interventions and ideas. We might offer intervention directly to the child and family. Professionals supporting the child might also be expected to take part in intervention programmes.

Before a referral to our Team, appropriate primary and secondary care assessments and interventions need to have been completed. For example, from a local Child and Adolescent Mental Health Service, Dietitian, Speech and Language Therapist and/or Occupational Therapist as appropriate. Please ensure information around this is included in the referral.

We require a completed referral form and reports from previous interventions to support us to make a decision about suitability for our Team.

We will contact you to gather further information if required to make a decision on suitability for our service. In 2021, we rejected 25% of referrals for incomplete referral information.

Please send the form below via email to gos-tr.pamhs@nhs.net

• Children from birth and up to their 16th birthday at the point of referral.
• The child’s limited food intake is driven by:
  • a fear of weight gain
  • concerns about body image, weight, and/or shape
  • specific fears (eg vomiting, choking) impacting eating
  • sensory sensitivities
  • a lack of interest in food and/or eating

• Children older than 16 years of age at the point of referral.
• Children and young people with acute weight loss or faltering growth presenting with significant physical or dietetic risk which requires more immediate medical and dietetic management by local healthcare teams.
• Children with comorbid medical conditions or physical health symptoms which may be impacting food intake where investigations have not been completed to rule out a medical cause.
• Children who have persistent physical symptoms (eg reflux, constipation, vomiting) which are not well managed.
• Children with unmanaged dysphagia.
• Children with developmental delay in which the food intake is in line with their developmental stage (rather than their chronological age), who require time and support from local professionals to acquire developmental skills pertinent to feeding.

• We consider previous interventions and whether we can offer advice and/or intervention beyond what local healthcare professionals can provide.
• Feeding difficulties are very common for children with neurodevelopmental conditions (eg ASD). We carefully consider whether the limited diet is beyond what might be expected for children with neurodevelopmental conditions and therefore warrants additional advice and support.
• We consider the developmental stage and motivation of the young person to engage with us and make changes to their diets.
• Feeding difficulties are often incredibly entrenched and require support from many parts of the system. Discharge from our service will be considered when suitable advice and recommendations have been provided to the family and professionals. Due to the nature of progress, which is long term and slow paced, we do not hold cases open for ongoing review for the change and progress to be carried out whilst under the care of our team.