A Day in the Life of a Franciscan Children’s Dietitian

This blog post was written by the Clinical Nutrition Department at Franciscan Children’s. If you have nutrition-related questions, please email us at info@fhfc.org or call 617-254-3800 x1350.

Have you ever wondered how a pediatric dietitian spends his or her day? At Franciscan Children’s, our dietitians work in variety of departments including Pediatric Rehabilitation, Pulmonary Rehabilitation, and Inpatient Mental Health.  In honor of the recent National Nutrition Month celebrations, we’ll break down the busy lives of the Franciscan Dietitians!

7:00 AM It’s an early start for Julie! She begins her day by preparing for the interdisciplinary rounds on the Pulmonary Rehabilitation unit. These weekly rounds include the many different disciplines that make up a patient’s care team, including:  the medical team, nurses, physical therapists, occupational therapists, speech language pathologists, child life specialists, chaplaincy – and clinical nutrition. Today, the team wants to see if a patient’s tube feeding schedule can be adjusted to allow more time “unhooked” from the feeding pump to work with the different therapies. Julie creates a new schedule that allows more time “off” while still making sure this patient gets all the nutrition they need to grow.

8:00 AM Emily comes in and checks on some patients she saw yesterday.  One of the first things she does is check that the tube feeding and infant formula recipes are up-to-date. At Franciscan, many of our inpatients are on customized recipes to provide optimal calories, protein, vitamins, and minerals. Any adjustment requires some calculations so that the Dining Services department can create the custom recipe.

9:30 AM Meanwhile, Laura is ready for her first outpatient of the day. This is a follow-up patient who was referred to her by a primary care physician in the Pediatrics department because of picky eating and poor weight gain. Laura meets with the patient and her mom to talk about ways to help her gain weight by trying new high-calorie, kid-friendly foods.

10:30 AM After rounds, Julie heads off to Feeding Team. Feeding Team is an outpatient multi-disciplinary group of therapists, including a feeding psychologist, occupational therapist, and a speech language pathologist. Today, this team is seeing a child with autism. She is a very selective eater and will only eat three foods. These foods have to be the same brand, temperature, and prepared the exact same way every day. Julie and the Feeding Team come up with ideas of ways to add a few new foods to help vary the patient’s diet and improve her nutrition.

11:30 AM Emily is on the Pediatric Rehabilitation unit to talk to a mom who is very excited because her baby is going home tomorrow! Emily is teaching mom how to prepare her child’s infant formula. This baby was born with a low birth weight and needs some extra calories to catch-up to other babies her age. This is why Emily has made a custom, high-calorie baby formula recipe. Emily also makes sure a dietitian will see the patient after discharge so this recipe can be changed as she grows.

12:00 PM Lunch time.  A dietitian has to eat, too!

1:00 PM While Julie is checking in on her patients, she gets a page.  A patient on the Pulmonary Rehabilitation unit has had lab tests come back and the medical team is wondering if there should be adjustments to the patient’s parenteral nutrition, or nutrition given through an IV. Parenteral nutrition is usually needed (as in this patient’s case) when the gastrointestinal tract isn’t working properly. With parenteral nutrition, the vitamins, minerals, electrolytes, and other nutrients need to be very carefully balanced to make sure there is not too little, nor too much, of these important nutrients. Julie speaks to the Pharmacy team about the best way to adjust this patient’s parenteral nutrition.

2:00 PM On the Pediatric Rehabilitation unit a new patient has just arrived. Laura heads upstairs to talk with the patient and his family. He recently had major surgery, and after surgery started being fed through a feeding tube. One of his goals at Franciscan Children’s is to work on eating more food so that the feeding tube can possibly be removed. Laura finds out what some of his favorite foods are and what his diet was like before surgery. Laura and the Speech Language Pathologist create an eating and tube feeding schedule to help encourage his appetite before meals, while still making sure he gets good nutrition.

3:00 PM  Julie heads to a family team meeting on the Pulmonary Rehabilitation unit to talk with the child’s parents and team about the progress the child is making with nutrition.  Julie shows the parents how their child is growing on the growth curve. This particular patient is small for her age, so Julie recommends increasing the amount of tube feeding the child gets.

3:30 PM Emily is on the Inpatient Mental Health unit to meet with a teenager who’s been experiencing weight gain from his new medication. With this side effect, there are several ways that changes in diet can be a big help. He’s feeling very hungry and having a harder time feeling full while eating. They talk about filling foods, like whole grains, whole fruits, veggies, and protein foods versus non-filling foods like juice, dessert, and refined grains. Together they come up with a plan of meal choices and snacks that are filling and he enjoys!

4:00 PM Julie heads to a meeting with other staff members from many different departments to talk about breast feeding and breast milk policies at Franciscan Children’s.  The group talks about how to encourage breast feeding among the parents of patients. They also discuss organizational policies regarding how breast milk is stored for the inpatients to make sure it is a safe, seamless process.

5:00 PM Before leaving for the day, Julie, Emily, and Laura make sure they’ve checked-in with care teams at Franciscan, parents, and each other for any nutrition updates.  If one thing is clear from a Franciscan dietitian’s day, it’s that dietitians don’t work alone! We work with many people at Franciscan Children’s with one goal in mind: helping children grow so that they can live their best life, and reach their fullest potential!