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Nutritional Healthy Start

The following pathway should not be read as stand-alone and MUST be read in conjunction with Section 3: Pathways.

  • This pathway focuses on infant feeding choices, promotion of breast feeding and growth concerns and its management.

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Birth - 6 weeks

Birth - 6 weeks

Support for vulnerable /targeted families centred on need.

Address individual needs of the family.

Childrens Centres & EYFS

Outreach home visiting family support - the service provision is needs led and encompasses issues such as:

  • Access for hard to reach families
  • Reduce risk of/actual child abuse/neglect
  • Facilitate access to health education focussing on baby feeding, weaning and wider nutritional issues
  • Support to access appropriate groups/specialist groups
  • Liaison with other agencies and communicate effectively and share information
  • Referrals where additional needs are presented for parenting support.

0 - 8 weeks

Additional visit in circumstances where there are concerns regarding:

  • Poor weight gain
  • Poor feeding

Health Visiting

In-depth assessment and management of growth where concerns exist, using WHO guidelines.

  • Provide assessment of baby’s weight. Greater than 10% below birth weight requires full assessment and at least a telephone discussion to paediatrician.
  • Identification of growth concerns, physiological deterioration, dehydration, inadequate feeding and babies causing clinical concern.
  • Monitoring and support to parents of children with pre- existing medical conditions.
  • Provide additional support with breast/formula - refer to local breastfeeding services where appropriate.
  • Seek advice/shared care from dietician, paediatrician and GP

For concerns regarding inadequate feeding a CAF should be undertaken and referral made to e.g. Childrens Community Nursing Team, Children’s Social Care Services, Children’s Centre for parental support

0 - 8 weeks

Core Purpose 1

Targeted Support

Facilitate Joint working and support integrated care planning.

Childrens Centres & EYFS

Working with the HV team provide specialist nutritional programmes to support the family to deal with a wide spectrum of nutritional issues.

Input into the CAF.

Birth - 1 year

Targeted Support

Facilitate Joint working and support integrated care planning.

Primary Care & GP

Working with other key partners provide support for families with issues that are affecting poor baby weight gain/growth.

Consider support and referral to specialist intervention services if required. Monitor results and ongoing care plan in partnership with midwife and HV team.

Input into the CAF.

6 weeks - 6 months

8 weeks - 6 months

Additional Visits

Health Visiting

In-depth assessment and management of growth where concerns exist, using WHO guidelines.

  • Identification of growth concerns, physiological deterioration, dehydration, inadequate feeding and babies causing clinical concern.
  • Monitoring and support to parents of children with pre- existing medical conditions.
  • Provide additional support with breast/formula - refer to local breastfeeding services where appropriate.
  • Observe feeding and management of faltering growth according to faltering growth guidance. Refer to either GP or Paediatrician with sustained drop through 2 or more weight centiles; should include length measurements.
  • Seek advice/shared care from dietician, paediatrician and GP
  • Referral to recognised commissioned specialist nutritional programme e.g. HENRY

For concerns regarding inadequate feeding a CAF should be undertaken and referral made to e.g. Children’s Community Nursing Team, Children’s Social Care Services, and Children’s Centre for parental support.

  • Referral to Allergy clinic.

8 weeks - 6 months

Core Purpose 1

Targeted Support

Facilitate Joint working and support integrated care planning.

Childrens Centres & EYFS

Working with the HV team provide specialist nutritional programmes to support the family to deal with a wide spectrum of nutritional issues.

Input into the CAF.

6 months - 1 year

6 months - 1 year

Additional Visits

Delivery of HENRY Programme

Health Visiting

In-depth assessment and management of growth where concerns exist using WHO guidelines.

  • Identification of growth concerns, physiological deterioration, dehydration, inadequate feeding and babies causing clinical concern.
  • Monitoring and support to parents of children with pre- existing medical conditions.
  • Observe feeding and management of faltering growth according to faltering growth guidance. Refer to either GP or Paediatrician with sustained drop through 2 or more weight centiles; should include length measurements.
  • Seek advice/shared care from dietician, paediatrician and GP
  • Referral to recognised commissioned specialist nutritional programme e.g. HENRY
  • For concerns regarding inadequate feeding a CAF should be undertaken and referral made to e.g. Children’s Community Nursing Team, Children’s Social Care Services, and Children’s Centre for parental support.
  • Referral to Allergy clinic.

6 months - 1 year

Core Purpose 1

Targeted Support

Facilitate Joint working and support integrated care planning.

Childrens Centres & EYFS

Working with the HV team provide specialist nutritional programmes to support the family to deal with a wide spectrum of nutritional issues.

Input into the CAF.

1 - 5 years

1 - 5 years

Additional Visits

Health Visiting

In-depth assessment and management of growth where concerns exist using WHO guidelines.

  • Identification of growth concerns, physiological deterioration, dehydration, inadequate feeding and babies causing clinical concern.
  • Monitoring and support to parents of children with pre- existing medical conditions.
  • Observe feeding and management of faltering growth according to faltering growth guidance. Refer to either GP or Paediatrician with sustained drop through 2 or more weight centiles; should include length measurements.
  • Seek advice/shared care from dietician, paediatrician and GP
  • Referral to recognised commissioned specialist nutritional programme e.g. HENRY Carnegie or mini-MEND.

Consider referral to Allergy clinic.

For concerns regarding inadequate feeding a CAF should be undertaken and referral made to e.g. Children’s Community Nursing Team, Children’s Social Care Services, and Children’s Centre for parental support.

1 - 5 years

Core Purpose 1

Targeted Support

Facilitate Joint working and support integrated care planning.

Childrens Centres & EYFS

Working with the HV team provide specialist nutritional programmes to support the family to deal with a wide spectrum of nutritional issues.

Input into the CAF.