1493 Infants attending the paediatric emergency department with feeding difficulties & referrals to nurse led infant feeding clinic

Background Infants with feeding difficulties are a common presentation to the Paediatric Emergency Department (PED). Families have often seen their General Practitioner/Health Visitor (HV) but have felt it necessary to attend the PED acutely, this has especially been an issue due to COVID with reduced access to Primary Care services. In Autumn 2020 a new pathway was introduced for PED clinicians to refer directly to a specific ‘Infant Feeding Clinic’ (IFC). This is run within the hospital by a Paediatric Nurse and HV. There are clear referral criteria and infants who have been assessed in PED are offered a virtual/face to face consultation.

Objectives To assess whether infants presenting to PED with feeding problems are being appropriately referred to IFC. To assess the presentation and management of infant feeding problems in the local paediatric population.

Methods Retrospective case-note audit on infants <6 months of age presenting with feeding difficulties over a 1 month period in Oct 2020 to the PED. Exclusions were: 1 cleft palate and 1 complex gastro issues. Notes were reviewed to assess infants referred to IFC. Referral criteria are: <6 months of age at time of referral, born at >34 weeks gestation, no known co-morbidities, no red flags as per regional Infant feeding pathway, no evidence of faltering growth.

Results 30 infants were identified attending with a feeding problem to the PED. Mean age was 58 days (range 3–149 days old), 25 were formula fed, 3 breast fed & 2 breast fed with formula top ups. There were a range of presenting complaints – the majority being ‘unsettled’ or ‘reflux’. 53% were first time parents, 33% had already seen their GP and 20% already attended an ED previously for the same problem. 58% of infants had no treatment, the remaining patients being prescribed hydrolysed formula (16%), gaviscon/carobel (23%) or Omeprazole (3%). Despite CMPA being 40% of patients’ final PED diagnosis only 16% were prescribed a hydrolysed formula (table 1).