The children at Children’s National Medical Center (CNMC) have something in common besides being adorable; they all need good nutrition to grow and develop. I love kids - I even listed “playing with dogs and babies” as part of my interests in my internship bio. While I didn’t see any dogs at CNMC, I did see a lot of cute babies. It took some self-restraint not to give all of them hugs, but I was there in a professional capacity to learn. The dietitians at CNMC taught me much about helping children meet their nutrient needs.
Having just finished my primary clinical rotation, my mind was still geared towards adult nutrition, so I had to adjust to the fact that children have completely different needs. Pretty much everything is different, from the feeding formulas to the calculations for nutrition prescriptions. Bye bye Mifflin St. Jeor! No longer could I calculate calorie needs without barely thinking; I had to take everything step by step again. When I rotated in general medicine, I used DRI for age to calculate protein and calorie needs. If the child was falling on their growth curve, though, I used an equation for catch-up growth which involved the DRI for age and ideal body weight, which is also determined quite differently than for adults. Needs for children in the oncology unit were calculated by REE (using the WHO or Schofield method) x a weight loss factor of 1.3-2. Needless to say, this was quite the learning experience.
The conditions of the children I observed were also very different from the common conditions of my patients at my primary clinical rotation. I encountered patients with failure to thrive, various neurological disorders, and some other disorders that I had never heard of such as eosinophilic esophagitis. I participated in the Keto Clinic, where families of children who experience seizures check in with the neurologist and the dietitian regarding the child’s ketogenic diet. In the oncology unit, I was able to learn so much about childhood cancer and see firsthand the ways cancer can affect nutrition status. I was fortunate to get training on some very complex cases, which I know will help me be a stronger dietitian.
Another aspect of CNMC that was different than my primary clinical rotation is that both of the dietitians I shadowed attended rounds every day. After seeing each patient, the doctors asked the dietitian if she had any comments, opinions, or concerns. This happens everyday, for every patient. Children need relatively more nutrition than adults, and in a faster time. If a child isn’t eating, you can’t wait 5 days before considering alternative nutrition, so the dietitian’s role is extremely important. In the oncology unit, the RD worked so closely with some families that she knew all the feeding habits and quirks of the child. This rotation allowed me to see a dietitian working closely with a doctor for the success of a patient, and that was pretty inspiring.
Overall, I was fascinated and blown away by the complexity of caring for children. I knew I would get a variety of experiences with this internship, but the rotation at CNMC solidified that. I now have finished five rotations, and have been exposed to so many different people and work settings, from food service to corporate wellness, and now to pediatric nutrition. Working with children at CNMC is an opportunity that many dietetic interns don’t get to experience, and I am very grateful for my short time there. I got a glimpse into the world of pediatric nutrition, and it is awesome.
Me at my case study presentation on failure to thrive and weight loss in a 6-month old female.