Don’t Let the Little Ones Intimidate You

Children’s National Medical Center’s lobby

By: Rachell Burgos

As I started my rotation at Children’s National Hospital, I couldn’t believe how excited I was to put into practice what I had recently learned during my clinical rotation – this time with little humans. I met the challenge of my clinical rotation and left knowing I had accomplished and learned a lot. However, I was a little nervous about starting out at Children’s since this was something completely different than what I had ever experienced. For twelve weeks I had solely focused on adults and for the next two weeks I would be learning and focusing exclusively on children.

About a week before my gastrointestinal inpatient and pulmonary rotations started, my preceptors made sure I was familiarized with some of the most used terminology and concepts.  I was also given case studies which challenged my usual thought process in regards to nutrient needs and tube feeding recommendations; I was beginning to see that children’s needs are much different than those of adults. 

My first day was finally here. To ensure that I would be arriving on time, I left my house at around 6:25am. My partner, Moira, and I arrived an hour early. Since I was nervous, I used this found time to once more review some of my assigned reading materials. Doing this settled my nerves and I was ready to hit the ground running when I met with my preceptor. The stakes seemed higher since I knew I would be working with sick children. 

Slowly, I started getting comfortable with the flow of things. For the next two weeks, I would attend general surgery, pulmonary/adolescent and academic case management rounds. This was very interesting to me because it allowed me to see how different disciplines interact with each other and the importance of each of them during a child’s hospital stay. I also appreciated being part of a teaching hospital where residents, fellows and attending doctors worked closely together to provide the best care possible. 

The kid-friendly hallways

From the very first day, I was encouraged to practice my clinical skills. I had to provide nutrition education to two teenage brothers who had recently had bariatric surgery and were advanced to a clear liquid diet. Nervousness kicked in as this would be my first time speaking to children in a clinical setting. As time went by, I was continually encouraged to speak to patients. Due to this, I was able to retrieve a three-day 24-hour recall for a young girl diagnosed with Crohn’s disease, complete various nutrition assessment and a nutrition screening, complete a follow-up, and speak with a teenager with a possible irritable bowel disease diagnosis.

Must-haves for my nutrition class

One of my most favorite, yet challenging experiences in the past two weeks was conducting two nutrition classes in the behavioral units for adolescents. The eating disorders dietitian, Laura, really needed some help with her workload so my preceptor encouraged me to do it. Throughout the day, the kiddos on these units would attend several classes to stay engaged. As Laura and I were buzzed into the unit, I was nervous. I had little time to prepare, yet I was about to get started. I asked them about their favorite foods, talked about MyPlate, did a MyPlate food group quiz and sudoku, had them come up with lunch meal ideas with all MyPlate food groups and played Pictionary. Most of the kids were respectful and engaged. By the end of the class, they seemed to really enjoy the activities I had chosen for them and connected with my teaching style. As a result, I had gained more confidence as a dietitian-to-be.

Moira and I manning the National Nutrition Month table

Another one of my favorite experiences included manning the National Nutrition Month table with Moira and the outpatient dietitian, Sydney. Throughout this month, we were focusing on the Mediterranean diet and highlighting certain foods weekly. The first week, we highlighted nuts and seeds. We had handouts, erasers, magnets and of course delicious trail mix snacks for people to try. During the second week, olives and hummus accompanied by pita chips were featured. This was such a hit! So many people took handouts and magnets and seemed engaged and interested. This cool opportunity showcased the importance of adapting a healthy lifestyle rather than going on a fad diet.

Overall, I had a great experience at Children’s National. I got to experience what it is like to work in a teaching hospital and how truly valuable pediatric dietitians are in the clinical setting. I was challenged to do things I had never done before and learned so much about pediatric nutritional needs. I really enjoyed learning about the specific caloric needs of babies, Crohn’s patients and cystic fibrosis patients. Learning about the Holliday Segar method, catchup growth equation and calculating enzymes were one of the biggest takeaways of my time at Children’s. I am so grateful for the time I had there and for the preceptors who took time out of their busy days to answer every one of my questions and to ensure I had a well rounded experience.

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