A survey of paediatric nutrition care in paediatric dietetics throughout the UK and Ireland

Background: Adult under-nutrition is well recognised and extensively researched, leading to the development of guidelines, policies and nutrition screening tools to address the problem (Brotherton et al., 2010), however, there is a little recognition of childhood under-nutrition in the developed world. Current estimates suggest that 8–79% of hospitalised children are at risk of under-nutrition (Stratton et al., 2003). Under-nutrition is slowly gaining greater recognition by healthcare professionals which in turn may increase the demands on dietetic services. The aim of the present survey was to examine current nutrition care in paediatric centres across the UK and Ireland. Methods: The Children's Nutrition Survey was undertaken during January and February 2010. Participating centres were asked to complete a 2-page questionnaire regarding nutrition services and practices within their centres. This questionnaire was adapted, with permission, from the BAPEN Adult Nutrition Screening Week 2010 questionnaire. Centres were asked to describe nutrition services, weighing and measuring procedures, referral rates, staff training and nutrition auditing practices. Due to the small sample size descriptive statistics were used Ethical approval was sought through the University of Ulster Research Ethics Committee. Results: Seven specialist paediatric hospitals and 20 district general/single wards participated in the survey. Thirteen hospitals (48%) reported the presence of a nutrition support team or nutrition steering committee. Only eight centres could define their referral rates (the percentage of referrals to dietetic services from total number of in-patients), of which five defined their rate as falling within the lowest quartile of 0–25%. Screening tools were being used in only four centres. Nutrition related information was routinely included in the discharge plan of only 6 (22%) centres surveyed. Centres that reported having a nutrition support team or steering committee tended to be more likely to record height on admission; however, this was not found to be statistically significant due to the small sample size (Table 1). Table 1. Impact of nutrition support teams/steering committees on defined nutrition practices Weight taken on admission n (%) Height taken on admission n (%) Nutrition Practices Audited n (%) Staff trained on nutrition topics/referral criteria Nutrition Support team/Steering committee (n = 13) 11 (85) 4 (31) 8 (62) 12 (92) No Nutrition Support team/Steering committee (n = 14) 13 (93) 0 (0) 1 (7) 9 (64) Discussion: In centres with a nutrition support team/steering committee height was more likely to be taken on admission, nutrition practices more likely to be audited and staff trained on nutrition topics and referral criteria. Although current NICE guidelines (2006) recommend all hospitals have a nutrition steering committee, this did not seem to be met by many centres. Nutrition screening guidelines (Brotherton et al., 2010) were not being met in many centres as only four reported using nutrition screening tools. The current study will contribute to future research examining how paediatric dietetic services adapt and deal with increasing demands on their services to provide evidence-based practice and quality dietetic services Conclusion: This small survey shows the current lack of uniformity in the way nutrition care is conducted in paediatric centres across the UK and Ireland and the benefit nutrition support teams/steering committees may have. References: Brotherton, A., Simmonds, N. & Stroud, M. (2010) Malnutrition Matters, Meeting quality standards in nutritional care. A toolkit for commissioners and providers in England. Available at http://www.bapen.org.uk. [Accessed on 27 August 2010. NICE. Nutrition Support in Adults: oral nutrition support, enteral tube feeding and parenteral nutrition, CG32. London, National Institute for Health and Clinical Excellence, 2006. Available at http://guidence.nice.org.uk/CG32/niceguidence/pdf/English. [Accessed on 6 October 2010]. Stratton, R. J., Green, C. J. & Elia, M. (2003) Disease-Related Malnutrition: An Evidence Based Approach to Treatment. UK, CAB International.