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Child & Adolescent Nutrition Education Rotations

Within this rotation I was given the opportunity to engage in children with a broad range of developmental disabilities within the CED at WVU, specifically the Feeding & Swallowing Clinic. This clinic took place every Thursday from 10 am until 12 pm. Below you will see the Nutrition Assessment sheet that I used as I worked with the Registered Dietitian - who is also the clinic coordinator.  

 

Each week we saw a new family that had been referred to the clinic due to the child having one (or more) of the following problems - 

  • weak suck

  • food spit out or falls out

  • food is left in the mouth in pockets

  • limited tongue, lips, or mouth movement

  • excessive gagging, coughing, or choking 

  • vomiting, nasal regurgitation, drooling

  • easil fatigued while eating

  • chronic open mouth posture

  • food is swallowed whole

  • child refused to advance from liquids (formula, breast milk) to solids

  • foods requiring chewing are refused

  • tongue thrusts after 8 months of age

  • completing a meal takes > 30 minutes

  • oral skill delay - the child cannot:

    • eat pureed food by 9 months

    • chew table foods by 18 months

    • drink from a regular cup by 24 months

  • has signs of aspiration including:

    • coughing, choking, gasping, wheezing during or after eating or drinking

    • breathing disruptions (apnea) during meals

    • choking on saliva

    • chronic congestion 

    • chronic low grade fever

    • frequent episodes of pneumonia

 

When the child (& family) come to the clinic they are assessed by an interdisciplinary team of professionals in areas of nutrition, occupational therapy, behavorial psychology, speech-language pathology, and social work. Together, the team works toward the following - 

The objectives of the clinic are:

  • Improve eating skills and behaviors

  • Improve physical growth and development

  • Improve the nutritional status of children

The clinic assists families in:

  • Promoting self-feeding

  • Increasing acceptance of food types and textures

  • Transitioning from tube feeding to eating by mouth

  • Improving sucking, chewing, biting and/or swallowing skills

  • Improving meal-time behaviors

  • Improving the quality of the diet

To obtain more about the Feeding & Swallowing Clinic or about other clinics offered, click on the following link _ WVU's CED

 

This opportunity presented me with an exceptional amount of new experience that I was never around before. I really enjoyed it! After being involved in the Feeding & Swallowing Clinic, I was endeavored to enhance the dietary recall tool that is currently in use within these families. This experience lead me to...

My Master's Problem Statement

Due to the different amount of nutrients and energy requirements needed by these children, it is important for the Registered Dietitian to properly assess what the child is presently consuming which is why I am focusing my Literature Review on this topic. By looking at prior published studies, I want to generate the 'best practices' that are currently out there in use within similar populations so that RD's can make the most appropriate recommendations that they possibly can for the child to maintain a healthy nutritional status. 

 

CED Nutrition Services Program

Nutrition Assessment

 

Name:                                                            Date of visit:

DOB:                                                               Age:

Diagnoses:

 

 

Illnesses/surgeries past year:

 

 

Did illnesses/surgeries impact:     _ mobility    _  muscle tone       _ weight         _ energy needs                        

_  other nutrient needs         _  feeding skills

 

 

Feeding route:

 

Water source:

 

Diet order:

 

 

Estimated intake (cals, pro, fluid):

Estimated needs (cals, pro, fluid):

 

 

Medications:

 

Do meds adversely affect (or potentially affect):   _  nutrient status     _  weight     _  feeding/appetite                                                               

 _  reflux        _ elimination     _  other ______________________________________

 

 

Allergies:

 

 

Vitamins: 

 

 

Feeding skills & gen’l diet:

 

 

Activity/mobility:

 

 

GI: appetite problems/changes/C/D/N/V/reflux:

 

 

Growth and Measurements

 

Birth weight: _______________      Gestational age: _____________       (term gestation = 37.5-42 weeks)

 _  prematurity:|LBW 3.3– .5 lb| VLBW 2.2– 3.29 lb| ELBW 2.2– 1.66 lb    _  micropremie: under 1.65 lb

_  suspected IUGR?

Weight:                                            Height:                                                HC:

Wt/age:                                           Ht/age:                                               HC/age:

Wt/ht:                                              BMI:                                                   BMI/age:

Desirable BMI:                                 Desirable weight:

Wrist:                                               Build    S   M   L                                  Waist circumf:

 

Visual assessment: underweight     thin     good weight      good weight for this child      overweight      obese

 

 

Does this child have any factors that can affect body components, weight & growth:

_ brain differences        _  microcephaly         _  IUGR           _   chronic medical illness        _  GI problems

_ medications      _   suspected endocrine problems     _  hypotonia       _   non ambulatory

_  suspected nutrient deficiency (calories, iron, zinc)          _ other factors _________________________________

 

Other info:

 

 

 

 

Assessment:

Able to keep up with nutrient needs by mouth?                     Feeding problems:

Diet quantity/quality:                                                           Weight & growth:

GI problems:                                                                         Vitamin concerns:

Medication concerns:                                                             Special nutn needs 2 diagnosis?

 

 

 

Weight goals/plans:

 

 

Nutritional goals/plans:

 

 

Diet goals/concerns:

 

 

Feeding goals/plans:

 

 

Tests/evals:

 

 

Other:

 

WIC Rotation

 

         For my Child & Adolescent Rotation I had the opportunity to intern at Women, Infants, and Children (WIC) in the Elkins, Buckhannon and Petersburg locations. I was able to see what the nutritionist/RD does within this community setting. I also had the opportunity to observe the breastfeeding counselor and see what they do and what they cover in a counseling appointment with a client.  

            When beginning this rotation, I did not know too much about pregnancy, breastfeeding, babies and infants. I really did learn a lot more about this area during the week. I also got to see different ages in women, many being within the teenage years and seeing the difference among these mothers from the older mothers. I was unsure of what to expect at a WIC facility. I have heard and had a class or two in college where a nutritionist would come and talk to the class about her job at WIC, but I still was not sure of how the actual facility ran as a whole. I always thought it was more of classroom style clinics where the clients would get in small groups and have discussions and lessons on nutrition and feeding their baby/child. It turned out not to be like that at all. Clients make appointments and come in, get their height, weight and hemoglobin checked and then sit down one-on-one with the nutritionist. The nutritionist would then show the mother the three different growth charts to see where their child plots based on the height for their age, weight for their age and the weight for height of that specific child. Showing the clients the growth charts I think lets them really get a visual on their chart based on other children their age without directly saying “your child is a bit overweight” or “your child is at risk for becoming obese”, etc. The clients have a chance to talk about any concerns they may have or any questions regarding the child’s eating habits, etc. The children can be included on a WIC food package until the age of 5 years old and the mother can receive benefits until 6 months after the baby is born if she is not breastfeeding or she can receive benefits for up to one year as long as she is breastfeeding. The program is designed this way because once the child reaches the age of 5, they will be starting school and can get school breakfast and lunch.

            The WIC program is very beneficial to those mothers who cannot afford the proper nutrition needed for their growing baby. It was nice that I got to see a few clinics and see how they each work and the see different populations. Many of the women who are seen are really appreciative of their benefits and seem to be truly interested in getting their child the adequate nutritional needs required for a healthy, growing baby. But like any other program giving benefits, some do take advantage of it. It is a shame and even disheartening to see people use their children like that, but there really is not anything you can do. For the most part, at least from the week of experience I interned, you can tell just by their attitudes when sitting in the nutritionist’s office one-on-one with the family during their nutrition counseling. Some women talk and talk and ask questions and want to know more. You can tell how much they really care for their child and want to do what is best for their child to be healthy. Some do not show that at all. They may come in with a bad attitude hardly even willing to answer any questions, they just want their benefits and be done.

            Also, during my rotation at WIC, a new computer is getting started in all facilities. At the locations that I interned, they had been using it for about a month, so it is still new and getting adjusted to that specific program, but they also knew how to navigate through it pretty well. The new program is WV Crossroads Production. It was cool that I got the opportunity to see the new system as well since every facility will be changing to it eventually.

            Overall, my rotation with WIC was a positive one and it really did exceed my expectations of what I thought it was going to be like. I was introduced to several wonderful nutritionists and/or RDs who were all very friendly and willing to teach me anything I wanted to know more about. I really appreciate all of their help and letting me come intern with them for a week!

For more information about the WV WIC program, please click here.

© 2013 by JustineHaney

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