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Nutrition and Dietetics

What is dietetics?

Dietitians assess, diagnose and treat diet and nutrition problems using evidence-based, scientific research on food, health and disease. This is translated into practical advice to enable individuals and their family or carers to make appropriate food and lifestyle choices. Working as part of a multidisciplinary team, Dietitians support adults and children whose diet is a major factor affecting their quality of life.

Our Nutrition and Dietetics service

Our team is made up of HCPC registered Dietitians, Dietetic Assistants and Dietetic Support staff.

We provide a service to inpatients and outpatients at The Queen Elizabeth Hospital and an outreach service to people in the community (to support enteral tube feeding in their own homes or nursing homes). We also provide regular dietetic clinics in most West Norfolk GP surgeries. Being an acute -based service with clinical outreach to the community we have the advantage of a seamless service across both primary and secondary care with a single point of contact for both.

Below are examples of the diseases or conditions where our Dietitians may offer support and advice: This support and advice may be ongoing or achieved through a single dietetic clinic appointment:

  • Following surgery or trauma
  • Intensive care
  • During treatment resulting in side effects that reduce appetite or make the process of eating difficult
  • To meet the needs of a preterm infant
  • Diabetes - Type 1, Type 2 and gestational diabetes
  • Cystic fibrosis
  • Coeliac disease
  • Food allergy
  • Inflamation Bowel Disease (IBD)
  • Irritable bowel syndrome or food intolerance
  • Kidney disease
  • Stroke
  • Heart disease (and cardiac rehab)
  • Neurological conditions
  • Malnutrition
  • Faltering growth
  • Management of pressure sores

This department does not offer a specialist service for eating disorders.

Our department works very closely with the Catering Department in Queen Elizabeth Hospital to ensure the nutritional adequacy of our inpatient meals and flexibility to meet individuals therapeutic needs and preferences. This, and close working with ward staff, enables us to demonstrate that we meet the requirements of the Care Quality Commission (CQC).

What to expect if you are coming to see a Dietitian for a clinic appointment

You should have received an appointment letter and this will state the date and time of your appointment and where the appointment is. It may be in your local GP Surgery, a community venue, North Cambridgeshire Hospital in Wisbech or in The Queen Elizabeth Hospital premises.

Most appointment letters will have a food diary enclosed with them, especially if it is an initial appointment. It is very useful for the appointment if you can use this diary to write down what you have been eating and drinking for three days prior to coming to the appointment. Try to include as much detail as possible - for example, we want to know whether you have skimmed milk or semi-skimmed and whether you have one Weetabix or two. Do you have sugar in your cup of tea? If it is difficult to describe the food or drink then bring the packet or food label with you. Please remember to bring your food diary with you when you visit us.

Please aim to arrive on time, if you are running late then please telephone to let us know (01553 613507), it may be the Dietitian can wait for you, or it may be that the appointment has to be re-booked for an alternative date.

It is fine to bring someone with you if you would like. Sometimes it is useful to have a second pair of ears to help remember the information you are provided with. We can arrange an interpreting service if another language is required, please let us know if you need this service.

It is possible you will have your height and weight measured and so you may be asked to remove your coat and shoes to enable this. If you would prefer not to be measured then please inform the Dietitian of this. You will not be forced to be measured, though it may be useful for the Dietitian when making any clinical decisions.

The Dietitian may ask you questions about yourself. This will be to gain a full account of your medical history and personal circumstances to help with making any clinical decisions and to devise a nutritional plan that is tailored to your individual needs. During your appointment you should expect to be listened to. It is ok to voice any concerns that you may have.

The Dietitian will devise a nutritional plan with your agreement. You may then be offered a follow up appointment if this is needed. Your referrer will be informed of the agreed nutritional plan.

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Making a referral or an appointment

Written or electronic referrals should be made to the department via the GP, Health Professionals or a Consultant.

Inpatients will be seen on the wards at Queen Elizabeth Hospital. For Outpatients and Community patients the appointment letter will specify where the appointment will be held. Patients may be seen in their own homes though only in exceptional circumstances. For certain conditions a group education session may be offered. Appointments for children are mainly at the Roxburgh Children's Centre in the Queen Elizabeth Hospital. We provide a dietetic service to care/residential homes.

Useful links

Contact details

Our Nutrition and Dietetics Department can be contacted by telephone on (01553) 613507.

Typically the phone is manned Monday to Friday 8am - 4pm. There is an answerphone in operation and this is checked and responded to regularly during week days.

If leaving us a message, please remember to include your name, date of birth or hospital number, and your telephone number so that we can return your call.

Paediatric Referral Criteria

Fussy Eaters - Restrictive Eating

We will accept referral for the following reasons:

  • Eating fewer than 10 different foods or excluding one or more of the following main food groups:
    • Fruit and Vegetables
    • Dairy foods
    • Starchy carbohydrates
    • Protein sources
In addition to at least one of the following:
  • Faltering growth
  • Evidence of nutritional deficiency
  • Evidence of symptoms or a physical condition that are significantly contributing to or a result of restricted nutritional intake. For example, constipation, diarrhoea, developmental delay or swallowing difficulties (dysphagia).
  • Prescribed medications significantly impacting on nutritional intake e.g. in ADHD
  • Social (environmental) concerns

For patients not meeting the above referral criteria please offer the following information.

Ages 1-4 years
Behaviour management: https://infantandtoddlerforum.org/toddlers-to-preschool/fussy-eating/
Healthy eating:https://infantandtoddlerforum.org/toddlers-to-preschool/

Ages 4-11 years
 Healthy eating: https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/ and https://www.nhs.uk/live-well/healthy-weight/childrens-weight/healthy-weight-children-advice-for-parents/

Ages 11+
Healthy eating: https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/ and https://www.nutrition.org.uk/life-stages/teenagers/

All ages
 The following services may be contacted for further support if felt appropriate:

Suspected or confirmed Avoidant Restrictive Food Intake Disorder - ARFID

Children and young people with ARFID should be seen by specialist multidisciplinary team. We will accept referral for one off assessment of nutritional intake and advice regarding dietary supplementation.

Coeliac Disease

We are currently accepting referrals and supporting queries for patients with Coeliac Disease in the following scenarios:

  • Newly diagnosed – we will aim to review within 2 weeks
  • Poorly controlled – patients with raised TTG levels
  • Evidence of nutritional deficiency
  • Weight loss or poor weight gain
  • At request of family where there are nutritional/dietary questions or concerns
  • When letter to school is required to provide gluten free diet

Further information

https://www.coeliac.org.uk/home/

Weight Management/Obesity

Currently referrals/queries are accepted if patient presents with the following:
  • Evidence of related co-morbidities such as increased blood pressure, high cholesterol, elevated blood sugar levels or fatty liver disease
  • Underlying medical diagnosis or medication prescription significantly contributing to excessive calorie intake
  • Social concerns or involvement of Children’s Services
Please refer or advise families to self-refer to the following services prior to making referral to dietitian:

Patients living in Norfolk: https://www.justonenorfolk.nhs.uk/healthylifestyles or call 0300 300 0123

Patients living in Cambridgeshire https://www.cambscommunityservices.nhs.uk/what-we-do/children-young-people-health-services-cambridgeshire/cambridgeshire-0-19-healthy-child-programme/being-healthy/making-healthy-choices or call 0300 029 50 50

Further information

The following websites may be useful for guidance on a healthy, balanced diet:

Cow's Milk Protein Allergy

We accept referrals for cow’s milk protein allergy only if the following guidance has been implemented. The ‘Guidelines for the management of suspected cow’s milk protein allergy’ and the integral pathway can be found here. 

Further information

Once guidance has been followed and patient has confirmed CMPA we suggest that patient utilises the following website:

https://patientwebinars.co.uk/condition/food-allergy-in-children/webinars/.

Other allergies / Multiple allergies

When immediate type of allergy is suspected please refer patient directly to allergy clinic.

We accept referrals for the delayed type of allergies on individual basis and ask for food and symptom diary to be completed and sent in first instance. Link to the diary can be found here (please bear with while we update this).

Patients with suspected multiple allergies should be referred to allergy service in first instance. Following the assessment in allergy clinic referral to dietitian is likely to be made by allergy nurse or doctor.

Prematurity

We accept referrals for infants born prematurely if:
  • They have comorbidity linked to nutrition such as faltering growth or allergy
  • Are not weaned off specialist formula after 6 months of age corrected for prematurity

Faltering Growth

We accept referrals for patients with faltering growth as defined by NICE NG 75 guidance which can be found here.

Please provide recent anthropometric measurements with the referral, otherwise the referral will be rejected.

All other referrals will be triaged on individual basis.