Infant Malnutrition Clinical Pathway — Outpatient Specialty Care and Primary Care

Referrals

The table below provides contact information and indications for referrals. Providers are encouraged to use the Outpatient Infant Malnutrition Management Pathway Smart Set to make referrals.

Referrals to consider	Contact Information	Indications for Referral
Nutrition	Phone Number: 267-425-3310 For families: Clinical Nutrition Outpatient Services	Any infant on this pathway
GI	Appointments and Referrals: 215-590-3630 Questions/More Information: 267-425-2739	Uncontrolled reflux or persistent vomiting Chronic diarrhea or severe constipation Symptoms of malabsorption Symptoms of IBD, celiac disease, pancreatic insufficiency, protein losing enteropathy, short gut/intestinal failure, motility or liver disorders Possible need for, or already on, parenteral nutrition Consideration for gastrostomy tube placement Vitamin deficiencies
Lactation	Phone Number: 215-590-4442, option #1 Email: lactation@chop.edu	Any infant on this pathway who is breastfeeding or receiving expressed breast milk
Feeding Team/Speech	Initial Appointments: 267-425-3333 For speech only: call feeding team and ask for "speech only" Questions/Concerns/Follow-Up Appointments: 215-590-7491	Feeding team: Inability to advance textures Picky eating/mealtime behaviors Swallow dysfunction Poor growth/nutrition Enteral tube feeding dependency Reliance on nutritional supplemental beverages Food refusal Speech: Signs of pharyngeal swallow dysfunction Inadequate oral motor skills for feeding Difficulty advancing to age-appropriate diet
Social Work	Phone Number: 215-590-2072	Psycho/social barriers to adequate nutrition e.g., concerns for neglect, food insecurity, housing difficulties, caregiver limitations Signs of postpartum depression
ENT	Phone Number: 215-590-3440	Tongue tie Laryngomalacia Breathing difficulty Choanal atresia Any congenital malformation

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.