The task
Assume that today's date is 22 October 2026. You have just completed Fraser's six-week dietetic review.
You are a paediatric dietitian at the community health centre. Using the information in the case notes, write a letter to Dr Brooke Gatenby, the paediatrician who referred Fraser, updating her on his progress and outlining the plan. Address the letter to Dr Brooke Gatenby, Paediatrician, Paediatric Outpatient Clinic, Children's Hospital, 40 Main Road. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Update letter.
Case notes
Patient details
- Name: Fraser Lennox
- DOB: 15/12/2025 (10 months)
- Primary carer: mother
- Referred by Dr Brooke Gatenby (paediatrician) 26/08/26: suspected non-IgE-mediated cow's milk protein allergy (CMPA), faltering growth
- Dietetic visits: initial 10/09/26; review today 22/10/26 (6/52)
Social background
- Lives with mother, father and sister (4 yrs)
- Father works fly-in fly-out, away 2/52 at a time
- Starting family day care 3 days/wk from 01/11/26
- Grandmother critical of mother for stopping breastfeeding at 3/12 → family tension
- Mother complained clinic car parking too expensive
Medical history
- Term delivery; birth wt 3.4 kg (50th centile)
- Standard cow's milk formula from 3/12
- From 5/12: vomiting after feeds, loose stools with mucus 5–6/day, eczema, irritability
- No immediate reactions (no urticaria, facial swelling or vomiting within minutes of feeds)
- Eczema: emollients; mild topical corticosteroid PRN (per GP)
- Immunisations up to date
- Sister: peanut allergy, carries adrenaline autoinjector
Initial dietetic assessment 10/09/26
- Wt 7.6 kg (~8th centile, ↓ from 50th at birth); length 70 cm (25th centile)
- Standard formula ceased → extensively hydrolysed formula (eHF) commenced on paediatrician's authority script
- All dairy removed from solids; mother educated re label reading and hidden milk sources
- Solids 3 meals/day, smooth → mashed textures
Review 22/10/26
- Wt 8.3 kg (~15th centile), ↑ 700 g in 6/52; length 71.5 cm
- Vomiting resolved; stools 1–2/day, soft, no mucus
- Eczema improved, mild patches only; sleeping better, less irritable
- eHF ~600 mL/day, accepting taste well; intake meets calcium requirements
- Solids: 3 meals + 2 snacks, lumpy and finger foods; iron-rich foods (meat, legumes, iron-fortified cereal) daily
- 1 accidental exposure 07/10 (grandmother gave yoghurt) → loose stools and ↑ eczema × 2 days; resolved. Mother has spoken to family
- Mother asked about plant-based 'milks' (rice, oat) — advised not suitable as main drink at this age; continue eHF
- Mother coping well; confident with label reading
Plan
- Continue eHF + strict dairy-free diet; mother to give written dairy-free plan to day care
- Repeat eHF authority prescription required before 15/11/26 — request from paediatrician
- Tolerance review: home milk ladder after ≥ 6/12 exclusion (~03/27, age ~15/12) if paediatrician agrees, given non-IgE presentation
- Dietetic review 3/12 (01/27): growth, intake, milk ladder planning
- Mother enjoys baking; requested dairy-free cake recipes — given
Who is reading, and what do they need?
Dr Gatenby referred Fraser and already knows the suspected non-IgE CMPA and faltering growth. She needs to see what the dietetic changes achieved, current growth and intake, and exactly what she is asked to do and by when. Detail should be outcome-focused and not repeat the referral history.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Wt 8.3 kg (~15th centile), up 700 g in 6/52 | Directly answers the faltering growth concern by comparing with 7.6 kg (~8th centile) at the initial visit. Length 71.5 cm completes the growth picture. |
| Vomiting resolved; stools 1–2/day, soft, no mucus | Gastrointestinal outcomes since starting eHF and removing dairy. They show response to the changes made. |
| Eczema improved, mild patches only; sleeping better | Completes the symptom picture the paediatrician was following since 5/12. |
| eHF ~600 mL/day; intake meets calcium requirements | Confirms the nutritional adequacy of the dairy-free diet, which is a key dietetic judgement for the paediatrician. |
| Accidental yoghurt exposure 07/10: loose stools, ↑ eczema × 2 days | Relevant to the tolerance plan and allergy picture. It is one resolved event, so report it briefly without drawing conclusions beyond the notes. |
| Repeat eHF authority script needed before 15/11/26 | A time-limited action for her, so it must be explicit with the deadline. |
| Home milk ladder after ≥ 6/12 exclusion (~03/27) if she agrees | Requires her agreement given the non-IgE presentation, so word it as a request. |
| Day care from 01/11; written dairy-free plan; dietetic review 3/12 (01/27) | Shows how the strict exclusion is maintained in a new setting and when follow-up occurs. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Mother complained clinic car parking too expensive | A service complaint with no bearing on Fraser's care. |
| Grandmother critical of mother for stopping breastfeeding; family tension | Family conflict, not a clinical matter. The exposure itself is reported without detailing the dispute. |
| Sister has peanut allergy and carries an adrenaline autoinjector | Trap: it looks like allergy history, but Fraser's presentation is non-IgE CMPA and the notes give no link to this plan. |
| Father fly-in fly-out; mother enjoys baking; cake recipes given | Social and practical detail that does not alter the plan or the paediatrician's decisions. |
| Immunisations up to date; eczema treatments per GP | Background she is unlikely to need repeated in a progress update. |
A paragraph plan for this case
Start with the purpose, the review date and a brief reminder of the referral reason and the changes made at the first visit. Next give the outcomes at review: growth, symptoms, intake, the single accidental exposure and the advice on plant-based milks. End with the plan, putting the two requests (prescription and milk ladder agreement) clearly and giving the review date.
Where candidates slip on this task
- State the prescription deadline as before 15/11/26 and make it a clear request. Do not bury it among progress details or leave the paediatrician to infer the need.
- Milk ladder timing is about 6 months of exclusion (~03/27), when Fraser is about 15 months. Do not confuse this with the 3-month dietetic review in 01/27.
- Report the yoghurt exposure and the plant-based milk advice accurately. Rice and oat drinks were advised against as the main drink at this age, and eHF continues; do not imply the family has changed formula.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Dietetics letter tasks
- Malnutrition in COPD - progress update update letter
- Gestational diabetes - patient relocating referral letter
- Home jejunostomy feeding after oesophagectomy referral letter
Your profession's guide: OET Dietetics. Layout and structure: OET letter format.
Questions about this task
Should the weight gain be given as a figure or a centile?
Give enough for the paediatrician to see the trend clearly: the weight, the gain over six weeks and the centile movement. Do not add interpretations beyond what the notes say.
How should the accidental exposure be handled?
Mention it briefly with its effects and resolution, as it is relevant to the dairy-free plan and later tolerance testing. Do not name family tension or blame, which belongs in leave-out.
Sources
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