Monday, April 29, 2013

Pediatric Hospitals: A Whole New Ball Game

Before my rotation at Children’s National Medical Center, I completed 10 weeks at the Baltimore VA Medical Center.  I felt pretty confident in my clinical skills and ready to try a different type of hospital.  I knew that that CNMC was going to be different, but I don’t think I really knew what to expect.  Here are what I think are the top differences between working with the adult population and pediatrics.
1.      Parents over Patients
When gathering information traditionally, you can just ask the patient how they have been feeling and so on.  When your patient is 18 months old, that becomes a less realistic scenario.  As a clinical practitioner, you need to direct your questions to the family members, usually parents, and work with them to provide the best care for your patient.  Usually, they are fully aware of feeding behaviors, symptoms and general habits so you still get all of the information you need. 
      A pediatric hospital can serve patients from birth through their 20’s so there is a wide range.  You need to develop your own clinical judgment to determine at what point the child is included in the conversation. 
2.      Calculating Needs and Evaluating Values
The calculations are different, which is something that I had not thought of ahead of time.  Rather than calculating needs in total calories or grams of protein, everything is presented in relation to the patient’s weight.  For example, the needs of an infant that weighs 3.73kg would be documented as 102kcal/kg/day rather than 380kcal.  Weight is constantly fluctuating so this is a more appropriate method. 
The reference ranges also differ depending on age.  At different stages of development the body has changing needs, so a value that is in range for a baby could be outrageously high for an 18 year old and vice versa.  Practitioners need to be tuned into these differences to give the most accurate assessments.
3.      Growth
Growth can be the main reason you are seeing this patient.  During my rotation, I was on the GI and General floors so many of our patients were underweight and came in for Failure to Thrive.  In adults, changes in weight can be important in addressing an acute condition while weight changes in a child can impact their development and affect them lifelong. 
My impression is that nutrition in the pediatric population can do more good by preventing these problems long term and setting a child up for a healthy life.
I learned a great deal during this rotation and these are only some of the highlights.  Pediatric nutrition is fascinating and I loved being able to work with this population.  If you ever find yourself in a pediatric population, just remember some of these differences to improve your understanding and hopefully the quality of care you are able to provide.

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