Adventures in Pediatrics

By: Rachel Coury

This week marks the end of my 2-week clinical pediatric rotation at Children's National Medical Center (CNMC) in DC. Children's is world-renowned for the innovative and extensive services they provide in treating kids who are sick. During my rotation, I had the opportunity to gain insight into a variety of unique specialities that their dietitians take part in. My first week was spent with an RD covering general pediatric medicine, neurosurgery, burns, and trauma units. I was able to learn about the ketogenic diet and how it is used as a treatment method for children with epilepsy. This diet is high in fat and very low in carbohydrates with a modest amount of protein. It is designed to keep the body in a prolonged state of ketosis, which has been shown to have a therapeutic effect in preventing seizures in this population, although the exact mechanism of its effect is still unknown.

I was able to see a young girl with Pica (a disease I thought only existed in textbooks) who preferred eating her hospital bracelet to an actual meal of food and performed an initial and follow-up assessment on an adolescent female with a redundant colon. This patient had been suffering from chronic constipation since age 4 prior to the discovery that she had extra loops of bowel in her large intestine making it more difficult for waste to pass through. She came to CNMC to get a colectomy and is hopeful that post-op her constipation issues will be a thing of the past.

My second week at Children's provided just as many interesting experiences. My preceptor covered the intestinal rehab, bowel/liver transplant, and home TPN services. I was impressed by her ability to whip out a TPN faster than I could whip out my calculator. She was part of a unique team who work with children who have short gut. Some of the kids have as little as 10 cm of their bowel remaining (compared to a normal bowel length of ~400 cm), which puts them at severe risk for malabsorption, dehydration, and poor growth. The intestinal rehab team works to ween these kids off TPN as they slowly advance their enteral feeds (we're talking 1 ml per week here if they're lucky). Their goal is to get the kids' short gut to function as closely as possible to a bowel of regular length and maintain adequate hydration as these kids' can suffer from extensive intestinal losses.

As you can see, my experience at Children's was very enriching and exciting. I'm sad to call tomorrow my last day here but am excited to move on to my next site and continue my progression towards becoming an RD.

Until next time!