By: Cameron Carter
What could be more ideal than counseling children and teens with their parents at Children’s National Hospital? Fortunately, I had that opportunity while working with a dietitian at their IDEAL clinic in Prince Georges and Howard County. The IDEAL clinic is an outpatient clinic that focuses on pediatric bariatric surgery and weight management. I was able to shadow a dietitian and get first-hand experience on nutrition counseling. Before this rotation, I was not aware that a teenager (16 years and older) could qualify for bariatric surgery. This rotation was very interesting, and I had a positive experience.
In relation to nutrition counseling, I was given the opportunity to counsel every patient that was seen in the IDEAL clinic during my rotation. I used counseling techniques like reflecting, asking open-ended questions, creating rapport, and providing nutrition education. I also practiced using motivational interviewing, another major technique used in the pediatric setting. One child I met with was not seeing much change to their body and was not fully committed to applying the information learned in previous sessions. Using motivational interviewing, I got the child to commit to a goal that they thought they could achieve. I also was able to work with the nurse practitioner or doctor that would see the patients after the nutrition counseling and debrief them on my session. I would give a synopsis of the counseling session to the nurse practitioner or doctor, telling them the struggles each patient was having as well as the goals they set for the next month. Having a coordinated healthcare team allowed each clinic to function smoothly and tend to the needs of a large number of patients.
One topic in pediatrics that most parents deal with is selective eating. Parents told me they struggled with trying to get their child to incorporate different types of vegetables in their diet or that their child eats the same foods and will not try new foods. I created this infographic to give parents a way to get their selective eater to implement new nutritious foods in their diet.
The biggest thing I learned was how important creating rapport is and how to gain the trust of pediatric patients. Since I was a new face, most of the patients I met with were a little shy or hesitant but as I created rapport and was able to find one or two things we both had in common. I was able to create a safe environment where the children felt comfortable. I learned that most children enjoy talking about the things they like to do, so I was able to get the kids guard down which allowed me to begin nutrition counseling. For example, I had a patient who typically did not enjoy coming for nutrition counseling open up and tell me about a hobby that even the current dietitian, who has seen the patient multiple times, knew nothing about. I was excited to hear the patient passionate about something and was able to get them to establish a goal by the end of the visit.
Overall, I learned with nutrition counseling many patients have different struggles with eating a nutritious diet. It is important to individualize the counseling experience and find out the foods they enjoy so I can help create a positive relationship with nutritious foods. I also learned how important it is to get the parents involved. I saw that most kids who had a supportive parent or relative had a decline in BMI after multiple visits with a dietitian. I felt very comfortable counseling in pediatrics and truly enjoyed the experience.