Interviewed by Erika Goyer, Hand to Hold Family Support Navigator
All children have unique nutritional needs – but this is especially true for babies who were preemies, micro-preemies, or who have special health care needs. Some infants are able to establish a feeding routine soon after they’re born. Others will need help to overcome structural or physiological barriers to feeding.
While your baby was in the NICU they were cared for by a NICU dietitian who monitored their nutrition, caloric intake, and growth. After your child is discharged you will need to continue to monitor their nutritional needs. A good discharge plan can help, but it is crucial that you follow-up with your pediatrician as well. Ideally, you and your doctors will seek the assistance of a pediatric dietitian who can work closely with you and your child to establish the best possible feeding routine for your baby.
This month Hand to Hold interviewed Leslie Ivey RD, LD. Leslie is a registered and licensed dietitian with Austin’s First Steps High Risk Follow-Up Clinic. She has five years of experience as a NICU dietitian at St. David’s Hospital, two year’s experience as a private practice dietitian working with both pediatric and adult clients, and has been working with NICU graduates at Austin’s First Steps clinic for a year and a half now since the clinic first opened.
What is your title and what was your program of study?
I am a Registered and Licensed Dietitian. I have a bachelor of science in Nutrition from the University of Texas at Austin and completed my internship through their Coordinated Program in Dietetics. The initials after my name refer to Registered Dietitian (RD) and Licensed Dietitian (LD). I am registered through the Commission on Dietetic Registration and licensed through the Texas State Board of Examiners of Dietitians.
What does a dietitian do?
A dietitian assesses the nutritional status of a patient or client and provides recommendations and education to address any nutrition concerns or to promote general healthy eating habits. Because a child’s nutrition status, starting at birth, significantly affects their physical growth and neurological status throughout their life, the focus in pediatrics is making sure the child is gaining weight and growing appropriately, his nutrient needs are met, and that we introduce healthy eating habits as early as possible so that those habits will follow them the rest of their life.
When would a family come and see you?
A family could see a dietitian any time they have nutrition questions or concerns. Referrals from a physician are not required. Because dietitians are involved in both the treatment and prevention of nutrition concerns, parents could see a dietitian to address a specific nutrition issue they are experiencing at home or just to receive general healthy eating information from a trusted and reliable source. Continued monitoring is needed for some children and a one time visit is needed for others.
Especially with high risk babies, addressing nutrition issues early is important to help the baby grow and develop to their greatest potential. Oftentimes parents receive conflicting information from the media, friends, and other health care professionals and they are just seeking advice from a specialist whose focus is just nutrition. Read more about Feeding Skills in Premature Infants.
What would you tell families they should expect at their first appointment?
At the child’s first appointment, we would obtain a detailed medical history. If the baby spent time in the NICU, a Discharge Summary from their NICU stay is very helpful. (See what a Discharge Summary might look like.) A detailed nutrition history is also taken, including: what formula, breast milk, or food the baby is taking, the baby’s feeding schedule, the child’s weight and growth history, and any nutrition issues the baby is having or concerns the parents are having (reflux, difficulties with the baby’s feedings, constipation, etc.). The more specific the information is, the more helpful to the dietitian. For example, a dietitian will want to know if your child has a history of NEC or is having problems swallowing. The baby will be weighed and measured and plotted on the growth chart according to their adjusted age, which is their age from their due date, not from their birth date. Any previous weight and measurements from their NICU discharge or previous pediatrician’s visits can also be plotted to better determine the baby’s growth curve. (See examples of a growth charts used for premature infants.) Nutrition issues will be discussed and recommendations for changes will be provided and a plan of care for any additional follow-up visits will be determined.
What roles do the parents need to play in their child’s therapy?
Because parents are the primary source of how, when, and what nutrition a child receives, they play a vital role in their child’s nutrition status. Feeding and growth challenges are a major source of stress in the home environment. Parents need to be armed with the most accurate and helpful information for their child’s specific issues to best address these problems at home. Consistency in following through with a practitioner’s recommendations is extremely important to determine if that plan of care is working for the child. Communication and feedback back to the practitioner is also very important to determine if there is a better plan of care that needs to be instituted. (Click here to find out more about keeping a medical history and download a template you can use for sharing this information with your child’s providers.)
♥ Read Hand to Hold’s article NICU to Home: A Perspective on Feeding Difficulties
What resources would you recommend for parents who want to find out more about your field?
Parents can visit the website for The Academy of Nutrition and Dietetics (www.eatright.org), which is our national organization for more information about Registered Dietitians.
What sort of licensing and certification do practitioners in your field go through?
A Registered Dietitian is a health care professional who has completed a Bachelor of Science degree in nutrition and/or a Master of Science degree in nutrition. These programs of study include rigorous coursework in the scientific areas of biochemistry, human anatomy and physiology classes. To achieve registration status (RD), a 900-hour dietetic internship must be completed and a national examination must be passed. In addition, continuing education is required to maintain registration status. Texas also requires that a dietitian be licensed (LD). Licensure establishes standards of professional responsibility. For more information, visit the Academy of Nutrition and Dietetics.
Some dietitians hold additional certifications in specialty areas, such as oncology, nephrology, pediatrics, gerontology, diabetes, and sports medicine.
What professional associations are you a member of?
I am a member of the Academy of Nutrition and Dietetics and PANDA (Pediatric and Neonatal Dietitians of Austin).
Watch Leslie’s video Preemie Nutrition: Nutritional Needs & Fortification
You might also be interested in
♥ Nourishing Your Premature Baby in the NICU by Amy Gates, RD, CSP, LD