After completing an eight-week rotation in a community hospital, two weeks of staff relief, and another two-week rotation at a different hospital, I was pretty confident in my clinical skills as a dietitian. Until I started my rotation at the Children’s National Medical Center…
Virtually every aspect of nutrition care in the pediatric population is different from adults. When my preceptor asked me about energy needs during the stress response, I responded confidentially with, “Energy needs are increased, of course!” Wrong. During critical illness pediatric needs are decreased and the acute stress response actually inhibits growth. While calculating a TPN regimen for a patient, I was concerned over the glucose infusion rate. In adults you typically want this to be about 5mg/kg/min; however in infants, it can go up to 15 mg/kg/min! And you don’t calculate a child’s ideal body weight using an equation; you plot it on a chart. There are different growth charts for premature infants, infants from birth to 24 months, children and adolescents aged 2-20 years old, and even for certain conditions such as trisomy 21 and cerebral palsy. What I came to realize, CHILDREN ARE NOT LITTLE ADULTS.
Infants and children are still growing and developing and therefore, require more calories, protein, vitamins/minerals and fluid per kilogram compared to adults. Pediatric patients are vulnerable to smaller changes in therapies, so even changing their continuous tube feeding regimen by 1 ml/hour can make a huge difference. With help from my awesome preceptors, I restored my confidence in my clinical skills!
In just the two weeks I got to spend at Children’s National I learned SO much. And this is one of the reasons I love clinical nutrition-you are on a constant learning curve and learn something new every day!