Reasons for Referral to a Multi-Disciplinary Feeding and Nutrition Clinic

Background: Feeding disorders in children are complex and may encompass medical, nutritional, feeding skill and psychosocial issues. These are managed in a multi-disciplinary clinic involving a doctor, dietician, speech therapist and psychologist.

Objective: To describe the underlying clinical reasons for referral to the feeding clinic, and the aetiologies for feeding difficulties encountered by children and their caregivers.

Methods: Retrospective analysis of the clinic database, which captures patient demographics, reason and source of referral, was performed to determine the reasons for referral in this population.

Results: There were 394 new patients between December 2012 and October 2018; 239 male (60.7%). The median age of referral was 28 months. Majority (40.9%) were referrals from the various paediatric subspecialty clinics within the institution, 15.2% from primary care practitioners and 12.7% from general paediatrics clinics.

The most common reason for referral was feed refusal (25.6%), followed by picky eating (18.0%) and failure to thrive (14.0%). 31.0% had multiple reasons for referral. The most common reasons for referral in children 2 years and younger were feed refusal (27.8%), failure to thrive (12.5%) and choking/ gagging (6.8%); the most common reasons in children above 2 years old were picky eating (28.0%), feed refusal (23.9%) and limited food variety (12.8%). Children above 2 years old were more likely to be referred for weight loss (15.1% vs 5.7%, p = 0.003), picky eating (28.0% vs 5.7%, p < 0.0005) and limited food variety (12.8% vs 1.1%, p < 0.0005), compared to children younger than 2 years. Children younger than 2 years were more likely to be referred for tube feeding (8.5% vs 1.4%, p = 0.001) and gastroesophageal reflux disease (4.5% vs 0%, p = 0.001).

Conclusion: Knowing the referral pattern allows us to have a better understanding of the various feeding issues faced in various populations, so as to tailor better patient care for each of them.