GP dilemma: Child malnutrition

How do I deal with parents who I think may not be feeding their child properly?

Dr Kirsa Morganti, medicolegal adviser at Medical Protection writes:
It is not uncommon for patients to comment that they are following a particular type of diet, either for weight loss purposes or for religious or cultural reasons. For an adult with capacity this is their choice and as a GP, your role is restricted to providing advice regarding the suitability of the diet and any limitations it may pose for their health.

However, young children are generally dependent on what their parents give them to eat, and poor diets can range from excessive sweet food intake (resulting in dental caries), through to specific strict diets with certain food categories excluded.

So what should you do if, after a careful history and examination, you have concerns regarding a child’s diet? 

Guidance from the GMC reminds us that our priority must always be the safety of the child or young person. It is therefore necessary to address your concern regarding the child’s diet, despite this perhaps being a difficult conversation with the parent. This should be done in a non-judgemental, supportive manner, explaining the importance of diet to their child’s health.

In making any assessment of the child’s best interests, you are required to consider the views of the parents, including cultural, religious or other beliefs and values. This family context is important in your assessment of whether further intervention may be required regarding the child’s diet.

Parents may be well aware of any dietary deficiencies of the diet they prefer their child to follow and further discussion may reveal that additional supplementation is ensuring the child’s nutritional needs are being met.

However, as many parents are unaware of the particular dietary needs of a growing child and may be quite shocked to discover their child may be malnourished, this discussion will require a sympathetic and supportive approach. 

When to refer

Unless you have specialised knowledge of dietary matters, it would be prudent to suggest referral to a paediatric dietician. This will provide the parents with access to specialised support and information which will define any deficiencies in the child’s diet. Ongoing dietetic support may also enable the family to follow a diet that is both in line with their beliefs and provides the appropriate nourishment for a growing child. 

It is important to monitor the family’s adherence to any referrals and ensure that the child is seen again in surgery for reassessment of weight/height and to review any symptoms previously elicited.

In the unfortunate situation of a parent not attending follow-up appointments for dietetic assessment, you may like to discuss any ongoing concerns you have with an experienced colleague. It may also be necessary to consider involving your local safeguarding lead.

However, your continued engagement with the family is important, both to encourage attendance at appointments and to enable ongoing monitoring of the child’s wellbeing, so diarise the child’s follow-up appointments as ones that need to be reviewed if the parents subsequently cancel and do not re-book to ensure the child does not get overlooked.

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