Friday, 9 July 2010

Paediatric dietetics

Building housing the Nutrition and Dietetic department
This week the focus was on paediatric dietetics. This is a fairly complex area, and is introduced at the start of the placement when we're still finding our feet because there isn't a whole lot we can do to contribute - later in the placement we need more straightforward cases to practise on.

I observed three paediatric outpatient clinics in the Dietetic department, which included children with cow's milk intolerance, coeliac disease, low weight for their age (now called 'faltering growth' rather than 'failure to thrive'), and high weight for their age (now called 'obese' rather than 'bonny' or 'chunky'). There were some children who have difficulty eating more than a very narrow range of food. Some parents were obviously well-informed about the need for dairy foods, fruit and vegetables. Some were not.

One interesting session was a 'feeding group' where the dietitian is joined by a speech & language therapist and a psychologist, to address particularly difficult issues that may have psychological, behavioural or clinical causes. I learned a lot about children, formula milk, calcium-containing non-dairy foods, parents, feeding and mealtimes. Fact: rice milk is not suitable for feeding to dairy-intolerant children under the age of five, because of the risk of arsenic contamination. Choose calcium-fortified oat milk or soya milk instead. No, I have no idea what they taste like, either.

It's not an area that particularly excites me, particularly as I find myself becoming quite tense about the behaviour of some of the children (and some of the parents), without the moderating effect of having had children of my own to compare with. Not all parents of naughty children are bad parents. Sometimes children are naughty in spite of their upbringing. All I know is that it must be particularly difficult to cope if one of your children isn't allowed to eat what the others do. Or won't eat anything except dry toast. Or vomits persistently and won't eat solids even though s/he is two years old.

I did get some practical, hands-on experience though, even if it was just weighing children and measuring their height. A particular highlight this week was my first 'Diet History', where I took down the salient features of a typical day's intake from a very articulate 8 year-old child with coeliac disease. This is actually more significant than it sounds, because it forms part of the assessment of my competence. In just eight weeks time, I should be proficient not just in taking diet histories, but in conducting the whole consultation, although with adults rather than 8 year-olds. It seems less unachievable now that I've actually taken the first step.

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