Peds

I started my pediatrics rotation this week – it is a whole different world. Like Laurie said, I really like the respect that dietitians get from the pediatricians. The other major plus, in my opinion, is the rapid feedback from our MNT interventions. The baby gains 40 g in a day, her ezcema clears up in a week, etc.

The major downside is seeing sick little kids with bad social situations - which was about 75% of our patients. Some was benign cluelessness, but too much of it was caregivers who for whatever reason were not adequately addressing their kid's needs. I struggled as much with my anger and sadness about that as I did with pediatric needs assessment.

Highlights of the week was a follow-up of a 6 month old FTT kid with a vegan mom. Mom was breastfeeding, but the baby was very underweight for his age. There were a number of possiblities for his malnutrition, including inadequate intake, poor quality of the breast milk, or malabsorption, and it turns out all three probably contributed. The RD who saw him initially immediately suspected it was a food allergy, because the baby had severe ezcema and his siblings had food allergies. The MDs thought it might be a milk-protein allergy and put him on a soy formula, which made his ezcema even worse. The weekend RD was consulted and recommended that they try him on an elemental formula (100% free amino acids) and d/c breastfeeding. They did, and when we saw him again, he had started gaining weight and his ezcema was vastly improved. He was able to go home at the end of the week. Mom's breastmilk was analyzed (and Mary Rose Tulley was consulted!), and it turned out to have half the protein that breastmilk normally has. Having learned that breast milk quality is not usually affected by nutritional status of the mother, I was pretty surprised by the lab results. It makes me worry about mom, especially since she really didn't want to formula feed her son and was going to try to cut soy out of her vegan diet. Eeek! I wish we could have provided some nutrition education for her, but for some reason we didn't/couldn't.

We saw a 4-year old who hasn't really grown since he was 2 years old, which was around the time he became a super picky eater who wouldn't eat anything except pizza, fries, chips, and OJ. He had been even been seeing a pediatrician regularly, but the lack of growth went uninvestigated because Mom and Dad were short. Uh..... He didn't even come in for FTT, though, but for unexplained edema and vomiting. They ran dozens of labs and tests to come up with a diagnosis (discovering in the process that his micronutrient labs were bad), but his condition is still unexplained. However, he does like the Resource Breeze juice box we gave him and was started on a multivitamin, so hopefully he'll start getting the nutrients he needs. I feel like that is a bandaid on the more serious problem of his disordered feeding behaviors, but my RD pointed out that the feeding behaviors is not something we can fix in the hospital. We did request a speech consult to assess the picky eating, and the ST gave the parents some tips to try to improve his intake.