Infant Feeding Difficulties Clinic (IFDC) & Paediatric Infant Feeding Allergy Clinic (IFAC) (Paediatric Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Presentation of symptoms suggestive of gastro-oesophageal reflux (IFDC)

For symptoms suggestive of reflux:

  • Back arching/pulling up legs/extreme discomfort
  • Extreme crying for >3-4 hrs/day for at least a week
  • Oral aversion: refusing feeds or taking small amount
  • Poor sleep (i.e. difficult to settle, not keen to lay on back, crying out in pain)
  • Regurgitation & at least one of the above symptoms
  • Coughing/hiccupping/wheezing/hoarse

First line advice: to follow prior to referral:

  1. Breast fed: ensure a full breastfeeding assessment is carried out by an appropriately trained Health Care Professional , ensuring positioning and attachment has been assessed as effective
  2. Formula fed: ensure feeding is responsive: feed to around 150ml/kg/day (1oz = 28ml) & try small frequent feeds
  3. Assess for tongue tie: If suspected, refer to: nhsh.specialistbreastfeedingclinic@nhs.scot 
    If no improvement:
  4. Breast Fed: Start a two week trial of GavisconInfant or Cow & Gate Instant Carobel. For Carobel give as a paste before feeding 3 scoops to 2oz EBM 
    Formula Fed: Start a two week trial of Carobel as follows:
    Start at:  ½ scoop of carobel for every 90mls/3oz of feed. If there is no improvement, then increase to 1 scoop – 1 ½ scoops per 90ml/3oz of feed. See separate information sheet on carobel.
    If no improvement to symptoms:
  5. Refer immediately to IFDC. Consider commence dispersible omeprazole at 1mg/kg once daily (with minimum dose of 5mg). It is good practice to provide omeprazole advice sheet Medicines for children

Formula Fed 

Breast Fed
Refer to the IFDC by emailing the IFDC/IFAC referral form to:
paediatricdietitians@highland.gov.uk

Refer to the Infant Feeding Adviser. Email address for referral: nhsh.specialistbreastfeedingclinic@nhs.scot

Presentation of symptoms suggestive of Cow’s milk protein allergy (CMPA) (IFAC)

For symptoms suggestive of CMPA:

  • Regurgitation with no signs of reflux
  • Loose stools +/- blood/mucus
  • Constipation
  • Discomfort after feeding
  • Painful wind
  • Skin rashes
  • Eczema/dry skin
  • Hives/swelling/immediate flare ups of eczema/rashes*
  1. Breastfed infantsrefer to specialist breastfeeding service via specialistbreastfeedingclinic@nhs.scot
  2. Formula fed: Commence 3 week trial of Extensively Hydrolysed Formula (e.g. Aptamil Pepti Syneo with Carobel (as above). Request 8 tins only on prescription and not for repeat script at this stage. AFTER 3 WKSRE-CHALLENGE back to standard formula*. Trial & re-challenge sheets are available from the dietitian.
  3. If symptoms resolve on EHF & reoccur on re-challenge: continue with EHF & immediately refer to IFAC via paediatric dietetics paediatricdietitians@highland.gov.uk

*DO NOT RE-CHALLENGE:  if IgE mediated CMPA is suspected i.e. Hives/swelling/immediate flare ups of eczema /rashes. Start EHF and refer immediately to dietetics 

Formula fed

Breast fed

Refer to the IFAC by emailing the IFDC/IFAC referral form to:
paediatricdietitians@highland.gov.uk

Refer to the Infant Feeding Adviser. Email address for referral: nhsh.specialistbreastfeedingclinic@nhs.scot

Abbreviation

AbbreviationMeaning
EHFExtensively hydrolysed
IFDCInfant Feeding Difficulties Clinic
IFACInfant Feeding Allergy Clinic

Editorial Information

Last reviewed: 30/08/2021

Next review date: 30/08/2024

Author(s): Paediatric Department .

Version: 1

Approved By: TAM Subgroup of the ADTC

Reviewer name(s): Lead Paediatric Dietitian.

Document Id: TAM336