Key Points:

• Nutritional Screening should be completed for all paediatric inpatients via Epic flowsheet 829 within the first 24 hours of admission

• Referrals for inpatient paediatric dietetic support should be completed in a timely manner via Epic order

• First line paediatric supplements are available to the ward for supporting patients prior to dietetic review

• Paediatric catering and menus vary across Frimley Park and Wexham Park but can provide a variety of options for different cultural and allergy reasons

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition. Print copies must be destroyed after use.

Abbreviations

This guideline is designed to support the inpatient paediatric ward staff across the Frimley Health Foundation Trust with supporting children and young people with eating difficulties. This covers the current catering practices for F1 and Ward 24 along with special menus for allergies, as well as nutritional screening required for all inpatient paediatric patients and how to subsequently refer to the paediatric dietitians. There is also guidance on utilising first line oral nutritional supplements when awaiting support from the dietetics team.

The provision of adequate and appropriate nutrition for infants, children and young people in hospital presents a significant challenge. It must take into account the diverse needs of the paediatric inpatient population in terms of age, developmental stage, ethnicity and religious beliefs. Furthermore, the provision of nutrition encompasses the requirements of the nutritionally well, the nutritionally vulnerable and those requiring therapeutic diets.

Data on prevalence of undernutrition amongst paediatric inpatients, indicate an incidence between 6%-41% (Pichler, 2014). A child’s nutritional status can deteriorate over the course of a hospital admission, therefore the use of a nutrition screening tool should provide a simple and rapid means of identifying those at risk and those who have specific dietary requirements.

Appropriate use of the screening tool will determine those who are at risk of undernutrition or faltering growth and should trigger a referral to a paediatric dietitian.

The Paediatric Nutritional Screening flowsheet will be able to identify those requiring therapeutic diets, those with chronic conditions requiring dietetic input (such as cystic fibrosis) and those who need specialist infant formulas, enteral feeds and parenteral nutrition. It is important that this is completed as part of the child’s admission (on Epic flowsheet 829) to highlight whether a referral is needed or special menus.

Completing the Nutrition Screening Tool on Epic:

1. Select patient you wish to refer and open the current inpatient encounter

2. Select the ‘Orders’ Tab

3. Search in the sidebar on the right-hand side for ‘Inpatient Consult to Dietetics’

4. Enter reason for consultation and click accept

5. Sign the order in the bottom right-hand corner

Referrals are triaged Monday-Friday between 08:30 and 14:30 by the paediatric dietetics team and actioned as appropriate.

If urgent support is needed, please complete referral and then contact the paediatric dietetics team during office hours (Mon to Fri 08.30-16.30)– Contact details via the staff extranet

If Discharged Before Seen:

If the patient is discharged before being seen please consider if an Outpatient Appointment would be beneficial.

If at Wexham, if a patient is going to continue under care of a Wexham Park Hospital Paediatrician after discharge they can be referred to paediatric outpatient dietetic service at Wexham Park Hospital via Epic. If they are not going to be under the care of a Wexham Park Hospital Paediatrician after discharge and require ongoing dietetic care they should be referred to the relevant community paediatric dietetics team.

If at Frimley please place a referral to the outpatient dietetics service via Epic for review at Frimley, they do not need to be under a paediatrician.

Hospital Menus

Children in hospital should be provided with breakfast, two main meals and snacks as required. Menu choices should meet the needs of those with specific dietary requirements, cultural or religious beliefs. There is more information about what is available at each site on the next page(s). Children at risk of undernutrition should be offered higher calorie snacks such as yoghurt, full fat milk, cheese and crackers, cake and biscuits. There are different catering systems, but each site aims to provide suitable meals for those with specific dietary requirements.

Food Provided by Parents/Carers

Commonly parents/carers will bring in meals and snacks for their child whilst they are an inpatient.

A microwave, fridge and kettle are provided in the parents’ room; however, parents or responsible adults must take full responsibility for the food they provide and its proper preparation.

Parents using these at risk therefore need to complete waiver form under consents on Epic for liability – as per SOP for “Patients Bringing In Food”, found on Staff extranet. See Appendix 1.

Breakfast choices and snacks are kept on F1. They are served in the morning by the ward host; snacks can be requested from ward staff. Staff can access the kitchen for those in need of additional snacks, sandwiches and drinks

Lunch and evening meal come from the ‘Thomas’ meal trolley. Unless otherwise requested, lunch is usually a selection of sandwiches, crisps, fruit, yoghurts, biscuits and cake slices. Drinks can be either water, milk, milkshake, fruit juice or squash.

The evening meal is bulk ordered for the ward and is a hot main course with a children’s choice as an extra. In some situations, a child/young person may be offered an individual menu, according to clinical need. Other menus can be accessed on Our Place or through the Ward Host.

Extras can be ordered via the C6 form from the kitchen e.g. toast for breakfast or an extra meal when they are open. C6 forms can either be accessed from the Ward Host or printed from Staff extranet, these must be taken to the kitchen with patient name and Ward Code along with what they would like, this can be completed by any member of the ward team

There is a small supply of baby food for infant who require these, these can be requested directly from the catering team in the main kitchen.

Allergy Menu

In the kitchen on F1 ward there are menu cards for those requiring special menus.

The following special menus can be downloaded directly from Staff extranet website and ordered by the ward including:

• Milk free

• Nut free

• Gluten/ wheat free

To order, please discuss with the ward host, have a look at the coding in the ward kitchen or liaise with catering on 134056 and ask to speak to the diet chef; all other allergy menus need to be ordered via the dietetics team. Please then refer in the usual way to the dietitian via Epic.

Cultural Diets

Certain diets can be catered for within the hospital. For more information about which meals can be provided, go to ‘Catering’ from the Staff extranet website and select special menus for FPH patients, then choose religious and cultural menus. There is a vegetarian option provided at all mealtimes.

Breakfast options such as toast, croissants, juice, yoghurt and cereals are provided in the morning between 7 and 10:30am.

Lunch and dinner options are discussed with ward staff at around 10am and special requests or sandwiches for lunch and dinner can be ordered at this time. Lunch options are based on the restaurant food for that day, and there is always a standard and vegetarian option. Dinner menu is specific to ward 24 and a menu can be found in the playroom or discussed with ward host.

Additional snacks can be requested throughout the day, as some are kept in the ward kitchen and others are kept in the hospital kitchen, which is open 7am-5pm. Options include sandwiches, yoghurts, juices, bread/toast with spreads (no GF option available if out of kitchen working hours), banana or strawberry milkshake cartons, crisps, cakes (including GF options), jelly, cereal (including GF options), hot chocolate, squash

On special request, ward host may be able to provide chips, jacket potato or salad with meals or cooked breakfast

Allergies should be discussed with the ward staff and ward host who should be able to provide appropriate options based off ward 24 menu. For patients with multiple or complex allergies, the adult allergen menu (free from the 14 main allergens) can be offered

Apple and pear purees can be requested from catering, but unfortunately there are no other baby food options provided by the hospital.

In certain circumstances, some patients may not be able to meet their nutritional requirements through food alone. This could be due to a number of reasons, including, poor appetite, poor swallow, increased energy requirements and eating disorder/disordered eating.

Supplement drinks (such as Fortini) are nutritionally balanced and provide additional energy, protein, vitamins and minerals and can be used as a supplement to food or as a sole source of nutrition (depending on volume used and age of patient).

Oral Nutrition Supplements (ONS) can be initiated on discussion with the ward dietitian to ensure the appropriate type and volume is given.

For more information (including suitability) for the Nutricia range use this link: https: https://www.nutricia.co.uk/patients-carers.html

• Supplements are best served cold but can also be served at room temperature, warmed or frozen

• Supplements can also be diluted with additional water/ milk based on tolerance

• Encourage supplement drinks between meals rather than in replacement

• Encourage slow sips

• Some patients may need assistance opening the straw and lid, or prefer the supplement in a cup

• Once opened, any supplement drink not finished after 4 hours should be discarded, to comply with the Ward Food Safety Guidelines IPC37 Frimley Guidelines.

• The amount of fluid taken should be documented on the fluid balance Flowsheet

Some patients may need to continue with supplement drinks after discharge from hospital. If this is a new prescription the dietitian will contact the GP to arrange a prescription and may provide a small supply for the patient to take home.

Please notify the dietitian as soon as you know that a patient is going home.

Ward Kitchen

A selection of Liquid sip feeds and high energy milks are kept in the cupboard in the ward kitchen on F1.

For Babies Under 8kg/12 Months

125ml and 200ml bottles of Infatrini are stocked and should be used first line. These should not be given if there are concerns about milk allergy.

Infatrini Peptisorb (200mls) is available as a high energy feed for infants who have a suspected milk sensitivity and faltering growth, but this must only be given in discussion with a consultant or dietitian.

For Children and Young People Over 1yr/8kg

At the weekend or out of hours, Fortini Multifibre can be offered until they are referred and other suitable options are arranged, unless they have their own supply. This should not be given if there are concerns about milk allergy and given to a maximum of 2x 200mls per day.

Re-ordering of Oral Nutrition Supplements

All supplements are provided by the dietitians. If more are required, please inform the dietetics department as soon as possible by calling the office (134053). Regular stock checks are completed to ensure that adequate stock is available.

If a patient comes in from home on a supplement and it is not available, then the parents should be encouraged to bring in a supply from home until suitable stocks are available.

The ward dietitian will aim to find suitable alternatives if their supplement is not available.

If a patient is being transferred to/from another hospital to/from FPH, they MUST have at least 7 days’ worth of supplements to ensure adequate supplies can be ordered or a suitable alternative found

Drug Treatment Room:

A selection of liquid sip feeds and high energy milks are kept in the cupboard in the drug treatment room on Ward 24.

For Babies Under 8kg/12 Months

125ml -200ml bottles of Infatrini are stocked and should be used first line. These should not be given if there are concerns about milk allergy.

Infatrini Peptisorb (200mls) is available as a high energy feed for infants who have a suspected milk sensitivity and faltering growth, but this must only be given in discussion with a consultant or dietitian.

For Children and Young People Over 1yr/8kg

At the weekend or out of hours, Fortini Multifibre can be offered until they are referred and other suitable options are arranged, unless they have their own supply. This should not be given if there are concerns about milk allergy and given to a maximum of 2x 200mls per day.

Ordering of ONS

Oral nutritional supplements are ordered by the dietetics team and kept in Catering. Oral nutritional supplements for patients should be ordered on PlanetFM and collected from catering by ward staff. If a supplement is unavailable, please contact paediatric dietitians for a suitable alternative (153232).

If a patient comes in from home on a supplement and it is not available, then the parents should be encouraged to bring in a supply from home until suitable stocks are available.

The ward dietitian will aim to find suitable alternatives if their supplement is not available.

If a patient is being transferred to/from another hospital to/from WPH, they MUST have at least 7 days’ worth of supplements to ensure adequate supplies can be ordered or a suitable alternative found.

Appendix 1: How to find the Food Waiver Form

Food Waiver Form:

1. Search in Epic Top bar for ‘Consents’

2. Type in Food Waiver Form to add a new document

3. Complete form with a patient/ carers and accept the form

This will then be available to review in Media

Pichler, J., Hill, S., Shaw, V. et al. Prevalence of undernutrition during hospitalisation in a children’s hospital: what happens during admission?. Eur J Clin Nutr 68, 730–735 (2014). https://doi.org/10.1038/ejcn.2014.21 [accessed 16 December 2025]

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

Version History

Related Documents