By Rachel Eldering
Prior to beginning my pediatric rotation at Children’s National Medical Center, I was warned that pediatrics is an entirely different world than general clinical dietetics. Reflecting back on my 2-week rotation, boy were they right! This rotation was my first hands-on experience with pediatric dietetics. I quickly learned that pediatrics has an entirely different way of doing things when it comes to calculations. I had to relearn Ideal Body Weight equations, fluid equations, calorie per kilogram ranges, and recommended grams of protein per kilogram. In addition, this rotation was also my first experience with a diabetes dietitian. I really enjoyed my rotation and learned all about the process a patient and family will go through when diagnosed with diabetes.
Patients with undiagnosed diabetes may be admitted to the hospital due to symptoms of hyperglycemia or diabetic ketoacidosis. Once the diabetes diagnosis is confirmed, a full day of education ensues. The diabetes team will look at the patient’s labs and work with the patient and family to determine a plan of care. The diabetes team consists of a physician, Certified Diabetes Care and Education Specialist, a dietitian, and a social worker. The education typically begins with a Certified Diabetes Care and Education Specialist. They will educate for about 2-3 hours and go over the basics of what diabetes is, what insulin is, how insulin works, and what their medication regimen will look like. The dietitian then begins providing education, which can take about 1-1.5 hours. This session will consist of determining what the patient’s diet looks like, teaching about the food groups, what foods consist of carbohydrates, what kinds of foods are important to have at each meal, and the timing of meals. One of the most important tips, my preceptor told me, is to have patients keep a scheduled eating routine. This helps with managing insulin regimens and stabilizing blood sugar levels. I also learned the importance of measuring food. Guessing how many carbohydrates are in a meal can be difficult and often leads to poor blood sugar control. This is a long day for the patient and family. They are dealing with the shock of a new medical diagnosis as well as an overload of new information. Luckily, patients and families continue to have support from the diabetes team after discharge. Parents are instructed to call each day following discharge to report blood sugar levels. This allows the team to see how the patient is doing and provide feedback. If a patient has a continuous glucose monitor blood sugar levels can be automatically sent to the team at Children’s.
Patients and families continue to come back to the hospital on an outpatient basis. They schedule appointments to see all the members of the diabetes team. At these appointments, the dietitian can get a picture of how well the patient feels they are doing, what their blood sugars generally look like, and what their diet looks like. The dietitian can then tailor education to their current needs and make health goals with the patient and family.
Outpatient counseling can consist of general healthy eating tips. I learned to recommend that the entire family eat the way the dietitian recommends so the patient does not feel left out or that they have to eat a “special” diet. The goal is to make sure the patient still feels normal. So, some common topics during an outpatient setting could include tasty ways to cook and season vegetables, how to use an air fryer, and easy carbohydrate-free snacks.
One of the most important tips I learned was tailoring education to the audience. Patients come from a wide range of backgrounds with varying levels of nutrition and diabetes knowledge. Diabetes may run in a patient’s family so the parents are very familiar with the diet education. In that case, education can be focused on areas they need the most help with. Comparatively, patients and families unfamiliar with diabetes may need more time focused on the basics.
This rotation exposed me to many different areas of clinical dietetics, including pediatrics, inpatient and outpatient diabetes, and general wellness counseling. I learned about the process a patient and family will go through when diagnosed with diabetes. In addition, I learned how to assess the educational needs of my patients and their families and gear each session to their needs.