Management

• Offer further blood test-coeliac screen, U and E’s, folate, b12, vitamin d, ferritin, FBC, thyroid function, liver function

• Offer stool sample for routine culture to rule out infection and calprotectin.

Note: Calprotectin testing is generally not recommended for children under the age of 5. This is because inflammatory bowel disease (IBD) is less common in this age group, and baseline faecal calprotectin levels are naturally higher, making the results more challenging to interpret. However, very early-onset IBD (VEO-IBD) can occur in children less than 5, so it is sensible to offer this to this particular child

• No need for F2F here as symptoms has not changed
• Advise mum not to stop gluten containing meals until investigations are done
• If initial test is positive, then you will refer to specialist. Also, if the test comes back negative, you will also refer to specialist as sometimes the test can come back falsely negative• Advise that if coeliac is confirmed, then the treatment is staying away from gluten. Inform her that she can access a range of gluten free products on prescription and also dietitians are available to guide her

• Encourage mum to continue to feed but do not force feed
• Liase with health visitors for constant monitoring of weight
• Safety net re dehydration-not wetting nappies, lethargy, unwell, blood in stools etc. And follow up in 1 week time to discuss results and see how things are going.