Introduction Feeding related problems are the commonest reason for readmission to hospital in the first fortnight of life. Our institution had a high referral and readmission rate for feeding difficulties due to a pragmatic policy of referral to paediatricians if the infant lost 10% of birth weight; fuelled by reports of serious hypernatraemic dehydration in the UK. A more liberal guideline tolerating 12% weight loss with frequent weight monitoring was introduced to reduce unnecessary referrals without compromising safety.

Aims To determine the effect of introduction of a more monitored but liberal weight loss guideline on hospital referral and readmission due to feeding difficulties.

Methods Referrals and admission to the Paediatric Admissions Unit (PAU) in the first fortnight were analysed before and after the introduction of new guideline. The new guideline was fully operational by December 2008. The data were collected over an identical 3 months period (July–September) in 2008 and 2009. Statistical analysis was performed using z test for proportions.

Results There was a significant reduction in 2009 of all referrals to PAU including referrals for poor feeding, weight loss and jaundice (table below). The incidence of hypernatraemic dehydration was similar in either year.

Conclusion The new liberal weight loss guideline is safe and reduces unnecessary referral to hospital due to feeding difficulties.