Quality standard

Quality statement 2: Feeding or eating history

Quality statement 2: Feeding or eating history

Quality statement

Babies and preschool children have a detailed feeding or eating history taken if there are concerns about faltering growth.

Rationale

A detailed feeding or eating history can help to identify any feeding or eating behaviours that might be contributing to faltering growth in a baby or preschool child. These could include, for example, ineffective milk transfer in breastfeeding babies, or food refusal in older babies and preschool children. There are also some physical disorders or developmental issues that can affect feeding or eating. Taking a detailed feeding or eating history also provides information about the calorific value of the baby or child's diet. Advice and care can then be tailored to their specific needs.

Quality measures

Structure

Evidence of local arrangements to ensure that healthcare professionals are trained to take a detailed feeding or eating history.

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

Process

Proportion of babies and preschool children who have a detailed feeding or eating history taken if there are concerns about faltering growth.

Numerator – the number in the denominator who have a detailed eating or feeding history taken.

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 or carers who feel supported if there are concerns that their baby or preschool child has faltering growth.

Numerator – the number in the denominator who feel supported.

Denominator – the number of parents or carers of 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 and health visiting services) ensure that healthcare professionals are trained, with input from secondary care paediatric services if appropriate, to take a detailed feeding or eating history if there are concerns about faltering growth in a baby or preschool child, and to provide advice based on this history. They ensure that healthcare professionals have enough time with babies or preschool children in whom there are concerns about faltering growth to obtain this history.

Healthcare professionals (such as midwives, GPs and health visitors) take a detailed feeding or eating history if there are concerns about faltering growth and provide tailored advice to the baby or preschool child's parents or carers based on this history. This advice should be given in a supportive and non-judgemental way. This can be done at the same time as a clinical, developmental and social assessment if one is being carried out.

Commissioners (such as clinical commissioning groups and local authorities) commission services that ensure healthcare professionals have the time and expertise to take detailed eating or feeding histories if there are concerns about faltering growth in babies or preschool children.

Babies and preschool children whose growth raises concerns have information about their feeding or eating habits recorded so that their parents or carers can be given advice on feeding and eating to help the baby or preschool child grow.

Definitions of terms used in this quality statement

Detailed feeding or eating history

In babies under 6 months a feeding history can include:

  • duration and frequency of breast or infant formula feeds per day

  • the numbers of wet and soiled nappies each day

  • in breastfed babies fed with formula, the type of formula given (for example first-stage formula), the amount and how it is being made up

  • any food being given and frequency

  • any behavioural issues such as feeding aversion.

In preschool children and babies over 6 months an eating history can include:

  • types of food being eaten

  • frequency of meals

  • food consumed between meals

  • amount of fluids, including any breast milk or infant formula, being consumed and frequency

  • eating environment, for example at the table with family

  • any behavioural issues, for example food aversion or avoidance.

The detailed feeding or eating history is tailored to the individual baby or child, taking into account a broad range of other factors such as age, severity of weight loss, social circumstances and the family's food choices. [NICE's full guideline on faltering growth: recognition and management of faltering growth in children 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 birth weight 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]