Background Children with chronic kidney disease require specialist renal paediatric dietetic care, regardless of disease severity or geographical location; however, under‐resourcing makes this challenging. Videoconsultation may offer a solution but research exploring its acceptability is limited. The present study explored parent/carer and child perspectives of videoconsultation as an alternative or supplement to existing regional dietetic care. Methods Children and families using a regional paediatric nephrology service were recruited through purposeful sampling techniques. Renal paediatric dietitians used existing hospital software to host videoconsultations with families. Perspectives were subsequently explored in telephone interviews with the children, their parents and separately with the renal dietitians. Data were transcribed verbatim and an inductive framework analysis conducted. Results Twelve families took part in the study, comprising 13 parents and five children (aged 9 months to 14 years). Two renal dietitians were also interviewed. Six themes emerged which were ‘Logistics’, ‘Understanding Information’, ‘Family Engagement’, ‘Establishing Trust’, ‘Willingness to Change’ and ‘Preferences’. Satisfaction with the videoconsultations was high, with no data security fears and only minor privacy concerns. Parents reported that screen‐sharing software enhanced their understanding, generating greater discussion and engagement compared to clinic and telephone contacts. Parents praised efficiencies and  improved access to specialist advice, requesting that videoconsultations supplement care. Children preferred videoconsultations outright. Conclusions Dietetic videoconsultations were acceptable to families and perceived to be a feasible, high‐quality complement to regional specialist dietetic care. Enhanced understanding and engagement might improve self‐care in adolescents. The acceptability and feasibility of videoconsultations could address inequitable regional service provision.

This prospective study showed that nutrition support with a specially formulated, paediatric peptide readymade feed was well tolerated, helped to promote growth, and can be considered suitable for use in infants with complex disease and faltering growth who are unable to tolerate a whole protein feed.

This systematic review summarises evidence regarding oral nutritional supplement (ONS) use in children with, or at risk of, faltering growth (FG). Ten randomised controlled trials (RCTs), compared changes in outcomes amongst children receiving ONS versus control were included. Overall, 1116 children (weighted mean (WM) age 5 years; n658 (59%) male) were recruited, of which 585 (52%) received ONS (WM intake contribution 412 kcal, 16.3 g protein, 395 ml) for 116 days (WM). ONS use was associated with significantly greater gains in weight (mean difference (MD) 0.4 kg, 95% CI [0.36, 0.44]) and height (MD 0.3 cm, 95% CI [0.03, 0.57]), likely related to improvements in nutritional intake. Mean compliance to prescribed dose was 98%. Data suggested an association between ONS use and reduced infections. Further research is warranted to establish ONS dosage and effects upon other outcomes. This review provides evidence to support use of ONS in the management of children with, or at risk of, FG.

The Care Quality Commission (CQC) launched in April 2010 (1) supports a quality of care outcomes framework for hospitals. Outcome 5-'Meeting Nutritional Needs' expects everybody admitted to hospital to be 'nutritionally screened within 24 hours of admission'. Following the CQC launch, the Bristol Royal Hospital for Children (BRHC) dietetic department led the implementation of the STAMP validated paediatric nutrition screening tool (2). Its suitability following implementation was evaluated. After piloting the tool on Paediatric medical and surgical wards it was rolled out across the hospital population. Data was collected between November 2010 and March 2011 as part of the CQC data collection. The hospital registered this data collection through the hospital audit team on a monthly basis in order to record compliance status, reporting back to the trust CQC governance lead. All children admitted for longer than 24 hours aged between 0-18 years were included. STAMP is currently only validated for children aged 2-16 years. STAMP only screened 56 % of our patient population as on average the other 44 % are less than 2 years of age. 17 % of patients are already under the care of the dietetic team-i.e. those with a chronic illness who have ongoing dietetic care. In order to streamline the nursing nutritional screening process to quickly identify children above 2 years of age and those children who were not already under the ongoing care of a dietitian, a Nutritional Screening Flow Chart (NSFC) was developed. The NSFC also triggers the nursing staff to inform the dietetic service when patients with the following conditions are admitted: Metabolic disorders, Cystic Fibrosis, Diabetes, Critical Care, Renal Failure, Bone Marrow Transplant or needing Ketogenic diets, as they will already be under dietetic care. In conclusion, STAMP is only useful to screen 39 % of BRHC patients as the remaining 61 % are either under the age of 2 or already part of an ongoing specialist dietetic caseload. STAMP, in isolation, is not a suitable screening tool for use across a paediatric tertiary inpatient establishment in order to fulfil the CQC requirements for Outcome 5. Alternative nutritional screening needs to be sought to identify malnutrition in under two's and prevent replication of screening patients already under the care of the hospital dietitians. The CQC should be made aware that there is currently no validated nurse-delivered screening tool that can identify malnutrition in 100% of children admitted to a tertiary paediatric hospital and need to adapt its outcome measures accordingly.