This information is intended for healthcare professionals

The Paediatric Dietitians are based at Kingston Hospital. We accept outpatient clinic referrals from GPs, health visitors, school nurses, speech and language therapists and other health care professionals in Kingston and Richmond. Some GP practices within the Kingston Borough have in-house Dietitians who provide a local service and referrals can also be made to these clinics. Please check with your relevant GP dietitian regarding which patients they are able to see.

We also accept referrals from internal services based at Kingston Hospital e.g. Neonatal Unit, Paediatricians and specialist nurses.

Due to high demand for the service and increasing waiting times we would appreciate your support with referrals by ensuring patients:

  • Meet the referral criteria 
  • Have already tried first line management (where appropriate, see below)
  • Registered with a GP locally (Kingston and Richmond area) or require joined up care with other teams at Kingston Hospital. Many of our neighbouring boroughs have community paediatric dietetic services or closer hospitals that it would be better for them to be referred to for continuity of care/access to local services.

Referral process

  • Referrals from local GPs should be made via e-RS.
  • Internal referrals are moving to CRS, in the meantime please email the department.
  • Other health professionals may refer by emailing the dietetic service (krft.dietetics@nhs.net) with the patient’s name, DOB, NHS or Hospital (MRN) number and clear reason for referral. We do not have a specific form to be completed, to ensure the referral process is user friendly, but it is essential to include weight and length/height history (with centiles) and clearly document any evidence of growth faltering. If you do not specify clear centiles/measurements, there is a chance that your referral may be rejected.
  • Paper referrals are no longer accepted.
  • We will not accept new referrals for patients whose care already falls under another local hospital (West Middlesex, St George’s or Epsom/St Helier’s).

Cancellations, rescheduling and non-attendances (DNAs)

  • Given increasing waiting times for our clinics, patients will be allowed to reschedule an appointment a maximum of 2 times whilst under our care.  Rescheduling on the day will be allowed once (unless there are exceptional circumstances). Patients will be discharged back to the referrer after this and will need to be referred back to dietetics.
  • Patients who DNA with no notice will be discharged back to their GP/ referrer after one missed appointment.  In the case of children who are considered at risk or have a child in need/ child protection plan, the social worker/health visitor/GP will be contacted and an attempt to reschedule with the patient will be made a second time. If they DNA again, we will discharge them back to the care of the GP. 
  • This will apply to both new patients and follow ups.

Referrals accepted by Paediatric Dietetics (general outpatient clinics)

  Criteria Notes (see also resources and guidance)
Growth faltering 

•    One or more of:
•    Weight crossed down 2 centiles if birthweight 9th-91st centiles
•    BMI <2nd centile
•    If under 2yo: weight >2 centiles below height, or weight <0.4th centile

Evidenced with weight and centile chart history

Infants are likely to need multidisciplinary review - ensure infant feeding team support and consider acute referral if poor weight gain in early days of life

Non-nutritional causes and Paediatrician referral should also be considered
Cow’s milk protein allergy (non-IgE) Diagnosis confirmed in primary care following re-challenge  
IgE-mediated food allergies/multiple food allergies Referrals accepted from hospital Paediatricians or Advanced Dietetic Practitioners  Must have had hospital Paediatrician or Allergy MDT input prior to Dietetic referral
Selective eating and restricted diets (moderate/severe)

One or more of:
•    Growth faltering criteria (as above)
•    Restricted diet at risk of nutritional deficiencies e.g. 2 or more food groups missing and unable to take a multivitamin/mineral supplement
•    Requires oral nutritional supplements to avoid malnutrition 
•    Enteral tube feeding being considered

See resources section for guidance on assessing diet and nutritional risk

Patients with severe presentation should be medically assessed for red flags (Medical Emergencies in Eating Disorders – Guidance on recognition and management) and are likely to need multidisciplinary review - consider urgent referral to Paediatrics
Weight management •    BMI ≥ 99.6th centile
•    BMI ≥ 91st centile with weight-related co-morbidity
•    High weight or rapid inappropriate weight gain in children < 2 years		  
Gastro Persistent abdominal symptoms or clinical concerns regarding food intolerances and dietary restrictions (after ruling out other causes e.g. Coeliac Disease, IBD)  
Other Persistent clinical concerns regarding diet despite first-line management provided in primary care  

Other dietetic services we provide:

Children and young people with the following conditions should be referred to Paediatrics at Kingston Hospital, where there are Dietitians within the MDT and/or Advanced Dietitian Practitioner clinics: 

  • Type 1 or Type 2 Diabetes 
  • IgE-mediated Allergy or Multiple Food Allergies
  • Coeliac Disease

There is also a Neonatal Dietetic Clinic that is exclusively booked by the dietitians for follow-up of babies under the care of the Neonatal Dietitian.
Children and Young People with a feeding tube will be seen in the community by the Paediatric Home Enteral Feeding (HEF) Dietitians.