Dr. Grace O'Malley:

Anybody who would be connected with Tusla would be referred to the hospital via a hospital consultant first. In tertiary care all patients are under a hospital consultant and are then sent wheresoever they need to go in the hospital.

We offer group treatment for families who can be treated in a group scenario. That depends on where they live, the age of the child and how the child and the parents are functioning. If they are able to work in a group dynamic, we encourage that because we get a peer effect. It is really helpful for parents to learn from one another and the teenagers and children learn from one another.

For 60% of our patient population, we see them in one to one clinics. That is more of a traditional outpatient clinic. The child first comes to the hospital and is seen by a consultant paediatrician, an endocrinologist or another medical consultant. The consultant then refers the patient to us and we see him or her in an assessment clinic. Such children will have screening from a physiotherapist, a dietician, and a psychologist. We very much believe in holistic assessment in order that we can really try to unpick what is the factor for this family that is important. Our treatment comes out of that.Sometimes the child is eating very well and the family is fully educated on how to eat well but there may be an issue around sleep, there could be real stressors in the family and it may be an issue that is for a psychologist or for mental health. Very rarely there are genetic conditions but that is dealt with in a different situation. At other times, it is more of a social problem and we have to try to link in. My colleagues, Dr. Sarah McGuire and Ms Michelle Strahan will speak on how we link in with other community supports. There is no step-down service for a child with obesity.

There is a wonderful team working in Tallaght community and we can refer patients to them, if the child lives in that area. That is the problem with community services. One has to come from that community to access services in the community. There may be dieticians working in areas around the country but there is no standardised acceptance of referrals. Unfortunately the paediatric dieticians are under such pressure that they have to prioritise children who are peg fed, that is, where the child is fed through a tube in their stomach. If those children have complex disabilities they will be seen before children with obesity because there simply are not enough posts.