Quality standard

Quality statement 3: Management plan

Quality statement 3: Management plan

Quality statement

Babies and preschool children have a management plan with specific goals if there are concerns about faltering growth.

Rationale

A management plan gives parents, carers and healthcare professionals a specific set of actions and goals, with regular reviews to check progress. Developing the management plan in collaboration with parents or carers provides them with clarity and reassurance about the actions that need to be taken and may help to reduce their anxiety about faltering growth in their child.

Quality measures

Structure

a) Evidence of local arrangements and written clinical protocols to ensure that the primary care team are trained to develop a management plan for babies and preschool children if there are concerns about faltering growth.

Data source: Local data collection, for example staff training records.

b) Evidence of local arrangements and written clinical protocols to ensure that the primary care team have access to healthcare professionals with expertise in faltering growth.

Data source: Local data collection, for example local care pathways and joint working agreements with primary and secondary care.

Process

Proportion of babies and preschool children in whom there are concerns about faltering growth who have a management plan that includes specific goals.

Numerator – the number in the denominator who have a management plan that includes specific goals.

Denominator – the number of babies and preschool children in whom there are concerns about faltering growth.

Data source: Local data collection, for example local audit of patient records.

Outcome

Proportion of parents and carers who are satisfied with the way concerns about faltering growth in their baby or preschool child are being managed.

Numerator – the number in the denominator who are satisfied with the way concerns are being managed.

Denominator – the number of parents and carers with babies or preschool children in whom there are concerns about faltering growth.

Data source: Local data collection, for example patient surveys.

What the quality statement means for different audiences

Service providers (such as maternity services, GP practices, health visiting services and paediatric secondary care services) ensure that primary care teams are trained to develop a management plan with parents or carers, tailored to the specific needs of the baby or preschool child. Primary care teams have access to healthcare professionals with expertise in faltering growth to help guide and implement the management plan, for example to agree when referral to secondary care may be needed.

Healthcare professionals (such as midwives, GPs, health visitors and healthcare professionals with expertise in faltering growth) work together to guide the development of management plans if there are concerns about faltering growth in a baby or preschool child. Primary care teams ensure they develop the management plan with the parents or carers, and with healthcare professionals who have expertise in faltering growth if needed. Healthcare professionals with expertise in faltering growth provide advice and support to primary care teams, for example agreeing when referral to secondary care may be necessary. GPs are made aware if a referral to secondary care is being made by another member of the primary care team.

Commissioners (such as clinical commissioning groups and local authorities) commission services that ensure primary and secondary care teams establish local care pathways and joint working agreements to provide planned care for babies and preschool children if there are concerns about faltering growth. They ensure that primary care teams develop management plans for babies or preschool children if there are concerns about faltering growth.

Babies or preschool children whose growth raises concerns have a plan that is decided together by the healthcare team looking after them and their parents or carers. This plan includes specific actions to improve the baby or child's growth and sets out dates when their growth will be checked again.

Definitions of terms used in this quality statement

Management plan with specific goals

A management plan developed by healthcare professionals working together with parents or carers that includes specific goals. The plan might also include:

  • assessments or investigations, for example serological testing for coeliac disease

  • interventions

  • clinical and growth monitoring

  • when reassessment to review progress and achievement of growth goals should happen

  • plans for referral to paediatric specialist care services if needed.

[NICE's guideline on faltering growth: recognition and management of faltering growth in children, recommendation 1.2.15 and expert opinion]

Concerns about faltering growth

This can include healthcare professionals being concerned about a baby or preschool child's growth, for example if they, or the parents or carers, think the baby or preschool child appears to be:

  • not feeding or eating

  • not growing as expected

  • thin or unwell.

Healthcare professionals may also have concerns about faltering growth in babies and preschool children if:

  • they lose more than 10% of their birthweight in the early days of life

  • they do not return to their birthweight by 3 weeks of age

  • there is a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile

  • there is a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles

  • there is a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile

  • the current weight is below the 2nd centile for age, whatever the birthweight.

[NICE's guideline on faltering growth: recognition and management of faltering growth in children, recommendations 1.1.5 and 1.2.1 and expert opinion]

Primary care team

This is the team providing community-based care for babies and preschool children where there are concerns about faltering growth or weight loss in the early days of life. This team includes, for example:

  • a midwife

  • a health visitor

  • a GP.

[NICE's guideline on faltering growth: recognition and management of faltering growth in children, recommendation 1.3.2]

Healthcare professionals with expertise in faltering growth

These are:

  • infant feeding specialists

  • consultant paediatricians

  • paediatric dietitians

  • speech and language therapists with expertise in feeding and eating difficulties

  • clinical psychologists

  • occupational therapists

  • lactation consultants.

[NICE's guideline on faltering growth: recognition and management of faltering growth in children, recommendation 1.3.3 and expert opinion]

Equality and diversity considerations

Healthcare professionals should ensure that the management plan takes into account issues such as cultural background and any particular food choices that are made by families or carers.

Parents or carers should be provided with information about the management plan that they can easily read and understand themselves, or with support, so they can communicate effectively with services. Information about the management plan should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and should be culturally appropriate and age appropriate. Parents or carers should have access to an interpreter or advocate if needed.

For parents or carers with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.