Clinics and wards used by dietetics services

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

These include:

• Cystic fibrosis, Respiratory and Intensive Care
• Haematology and oncology , Immunology and Bone Marrow Transplant (BMT)
• Immunology and Infectious diseases
• Cardiology
• Neurology, Neurodisability, Neuromuscular, Neurosurgery and Ketogenic diet for epilepsy
• Nephrology and Urology
• Child and Adolescent Mental Health and the Feeding team
• Gastroenterology
• Surgery and Orthopaedics
• Metabolic medicine
• Endocrinology
• Ear, nose and throat (ENT), Cleft palate, Plastic surgery, Craniofacial, Dental and Maxillofacial surgery
• Rheumatology and Dermatology (including Epidermolysis bullosa)

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

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.

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).

Children with these conditions 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 having treatment for immunological diseases and bone marrow transplantation will require a neutropenic diet to reduce the risk of food borne infections. Suitable meals and snacks are available on the ward menu. In addition, nutrition support including tube feeding and parenteral nutrition, is frequently required to support nutritional intakes and appropriate growth.

• If your child is undergoing cancer treatment and is struggling to eat, read the resource the Children's Cancer and Leukaemia Group recommends.

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

Please see this information sheet from the Cardiology dietitians:

• Feeding your baby with Congenital Heart Disease before surgery information sheet (577 KB)

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 dietitian 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.

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:

• An overview of the ketogenic diet: information sheet for patients

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 

Please see these information sheets from the Nephrology dietitians:

• Keeping to your daily fluid allowance (503.54 KB)
• Reducing your phosphate intake (361.4 KB)
• Reducing your potassium intake (2024)
• Reducing your salt intake (2024)

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.

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.

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.

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.

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.