A Peek at the Experiences of a Pediatric Intern

 Written by: Julia Shoemaker, Dietetic Intern

“I don’t know how you can work with that age.”

“Kids are crazy, I could never do it.”

“Isn’t it super sad?”

“Kids scare me!”

These are just a few of the responses I have received since beginning my internship as a pediatric dietetic intern here at Saint Louis University. I get loads of positivity from people as well, but the above comments are the responses that encourage me to express and share my passion towards working with the pediatric population.

Throughout this blog post, I want to talk about the rewarding aspects of being a pediatric intern, what kind of experiences we get, and share a few things I have learned this year when working with children from my own opportunities and preceptor guidance.

Are there days where I’ve been weak in the knees due to encountering something extremely sad? Or times where I’ve been sick to my stomach from hearing something I never imagined hearing about a child’s experience? Absolutely! But, it’s the occasional goofy knock knock joke, or that child that lights up when you ask them about their favorite foods, or that growth chart that FINALLY takes a turn for the better after a child has been struggling to grow/gain weight, or the excitement in a parent’s face that finally sees improvements in their extremely ill child that makes every bit of working with this population the most rewarding experience.

As a pediatric intern, we have a very similar experience to the Medical Nutrition Therapy (MNT) track. The main difference between the two tracks is that during the second half of the program, our clinical home is at Cardinal Glennon Children’s hospital or Saint Louis Children’s Hospital. I have spent some time at both of these facilities and they are truly wonderful places to work. You can almost feel the positivity in the air while working with the other health care providers there. It is definite that everyone in the hospital is working provide the best that they can for each patient. Along with this experience with pediatrics, we also get a broad range of experience with the adult population. This helps us to be equipped to work with any age group we want when we graduate. So, if we really do come out of this with the feeling that pediatrics just is not our thing, we have options. 

We also have the opportunity to go to various health fairs hosted for children during the year. These have been quite different this year due to COVID, but I have still had the opportunity to attend a couple events for the kiddos! The health fairs I had the ability to attend were Give Kids A Smile and Tiny Smiles. For these event, kids come and have a dental visit and then they get to come hang out with the dietetic interns to get weighed, measure, and educated about healthy habits. It’s a fun event that allows us to interact with kids in the community and attempt to make a difference very early in the child’s life. This gives us a chance to experience a community type setting, which is quite different than the clinical setting. We also get real life experience using paper growth charts and talking to parents about where their children stand on these charts. It’s great practice working with both kids and parents, which is a valuable skill set that one will need when working with pediatrics.

This is a picture of me at the Tiny Smiles health fair that we did in the fall.

I have truly learned so much throughout the last year of my internship. With little previous experience working in the field of pediatrics, I’ve tried to quickly catch on to various tips and tricks to use with the kids. I’ve learned that it is very important to involve the child in conversations that you are having while in their room. If the child is old enough to be involved and the conversation is appropriate, this is a great way to form a bond and make the child feel comfortable. The hospital is a scary place, especially as a child that may have little understanding about what is going on. I remember being deathly afraid of going to the doctor or having any type of medical appointment as a child, and feel that this has helped me to better empathize with these patients. It seems so unfair what these children are going through and there is not a thing they have done to deserve being in the position they are in. Making them feel better for even a short amount of time is so important to me. Walking into their room with a smile and trying to distract them from the scary hospital situation by talking to them about nutrition is a great way to help them feel better or even joyful for a little bit. 

One of my favorite aspects about working with the pediatric population is that I get to talk to the kids about food. I’m not the one coming in to poke or prod them with needles, draw their blood, or anything of the sort. I am simply there to make sure they are nourished and have a conversation about one of a human being’s favorite things, food! I’ve learned that so many parents will do whatever it takes to help their child get better, and the fact that they are leaning on us to help is so amazing.

Another amazing aspect of working with the pediatric population is the fact that we get to watch these children grow. Through ensuring children are getting the right amount of nutrition, we can physically watch their growth charts move and see that what we are doing for them is truly helping them get better or become healthier. It’s such a good feeling when a parent puts their trust into you as a professional to take care or their child. Though this is not the case with every family, many of them really do look to you for your professional advice because they are willing to do whatever it takes. The fact that these patients and parents often do rely on your advice and act on it really is a breath of fresh air.

This is a picture of a fun kid friendly cooking demo I did during my internship year.

Throughout this year, I have realized that working with children is a great way to build a healthier future for our world. A child that has not yet formed unhealthy habits is much more likely to make the healthy changes that we urge people to make as future dietitians and registered dietitians. I feel that this is another reason I am drawn to working with children. I want to help form healthier generations ahead and I believe that this can be accomplished through nutrition education at a young age. Not only do we have the opportunity to mold healthy habits in children, but we also have an opportunity to teach parents healthier ways of living by talking to them about their child’s health. As dietitians, it is our job to get through to this age group and help them to form these healthy habits early on. We must give them the tools that they need, because no one is equipped in the way we are to do so. Not only should we be pushing the healthy habits, but also educating them on why they are so very important. I hope that throughout my career I see this shift towards healthier lifestyles early in life, and plan to do what I can to make this happen.

With all of this being said, is working with this population sad from time to time? Yes. Are there days where you want to breakdown over a situation with a sick or injured child or after hearing a sad experience? Absolutely. Are kids sometimes a little silly or crazy? Of course. BUT the rewarding feeling you get when you help a child in need really does outweigh the bad days you will have in this job. Most kids truly are so pure and their personalities shine through unapologetically at all times, which is simply amazing and sometimes hard to find in the adult population. Knowing, seeing, or hearing that I have made a difference in a child’s life is worth every single bit of time that I’ve put into schooling/training for this profession. I truly cannot wait to become a registered dietitian and continue to build a healthier world through educating younger generations.

Should You Take a Home Food Sensitivity Test?

 Written by Eris Rolves, SLU Dietetic Intern

I frequently get targeted advertisements all over my Facebook and Instagram accounts for services that provide home food sensitivity tests. Oh, the joys of being an RD to be – your search history from academic research and Googling of medical terms easily spills over into your personal Internet browsing! Like the ad intended, it caught my eye and convinced me to stop scrolling, but not for the reason you may think. I examined the ad with skepticism instead of intrigue.

These home food sensitivity tests are marketed as an easy and cost-effective way to pinpoint what foods you are supposedly intolerant to. For those of us who frequently experience unexplained gastrointestinal distress, this appears to be the answer to our prayers at first glance. No doctors appointments, invasive procedures, or additional suffering? Just fork over a couple hundred dollars to have a company analyze my blood, saliva, or hair sample and return a list of foods that make my belly hurt? Seems like a straightforward, easy solution. However, it also seems too good to be true, and I hate to be the bearer of bad news, but these home food sensitivity tests most definitely are. Allow me to dig into the details of why.

https://cdn.pixabay.com/photo/2017/10/06/04/24/abdominal-pain-2821941_1280.jpg

Defining “Food Sensitivity”

It’s important to keep in mind that “food sensitivity” is not a medical diagnosis. This means that there are no formal criteria for identifying a food sensitivity, so the term isn’t really recognized in medicine. What can be diagnosed, though, are food intolerances and food allergies.

A food intolerance is developed when your digestive system is unable to properly digest or absorb a certain food, causing pain or damage to the GI tract. Gluten and lactose intolerance are two common ailments that fall into this group. Chances are, your adverse reaction to a certain food is related to intolerance, not an allergy.

A food allergy is significantly more severe and stems from the immune system. In a food allergy, your body reacts to a certain food through the digestive system, respiratory system, and the skin. Anaphylaxis can even occur, which is a life-threatening side effect that can include difficulty breathing, dizziness, and/or loss of consciousness. Food allergies are serious and should be diagnosed by a physician, not a home test.

https://www.aaaai.org/conditions-and-treatments/library/allergy-library/food-intolerance

https://www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058538

Why can’t food sensitivity tests diagnose a food intolerance or allergy?

These home tests and diagnostic medical tests are not looking for the same thing. Let’s have a quick science lesson: Your immune system protects you by developing antibodies in response to outside invaders it comes in contact with. The antibodies are custom-made by your body to fight off specific invaders, and there are several types of antibodies, called immunoglobulins (abbreviated Ig). Food allergies are measured and diagnosed by the presence of IgE antibodies. It’s not entirely clear why, but IgE antibodies are made in response to proteins in certain foods that your body deems to be a threat, resulting in an extreme immune response when that food is eaten (cramps/diarrhea, vomiting, hives, swelling, anaphylaxis). Home food sensitivity tests measure the presence of IgG antibodies, which can be made in response to any food and doesn’t necessarily result in that extreme reaction from the immune system. Again, it isn’t clear why IgG antibodies are made in the first place, but most people have IgG antibodies for quite a few foods.

By measuring the presence of IgG antibodies in your sample, the test is likely to return to you a laundry list of foods you are “sensitive” to – and on top of that, foods that you probably eat regularly. This leads to people following an unnecessarily restrictive diet. Anyone with a diagnosed food allergy or intolerance can attest that having to bend over backwards to avoid their trigger foods is not enjoyable. Why do that if you don’t have to?

A more in-depth explanation of why home food sensitivity tests are not effective can be found here: https://www.jaci-inpractice.org/article/S2213-2198%2817%2930704-3/fulltext#sec2

https://www.istockphoto.com/photo/antibody-immunoglobulin-gm1219978307-357047077

If food sensitivity tests aren’t accurate, why do people feel better after following the results?

If you read the comments on the social media ads for the food sensitivity tests, you’ll scroll through hundreds of comments of people saying that the test was “the only thing that helped them figure out what was wrong with them” and they’ve “never felt better” since cutting out all the foods on their results list. How can this be? One might feel this way for a couple of reasons. First, the placebo effect. Someone who is well aware that they are trying out this new diet that’s supposed to completely alleviate their symptoms may be convinced that it’s working for a while until proven otherwise. Second, that long list of trigger foods the test generated probably did contain a problematic food or two for them, and they are successfully avoiding them along with a dozen others.

There is really no advantage to avoiding foods that do not cause an adverse reaction. Like I mentioned, these tests tend to implicate foods that you eat often, so it would be a major adjustment to remove them from your diet, and a disappointing one at that. Unless your favorite food happens to be the trigger food, a diet without the joy it brings is not recommended, nor is it a healthy one.

Additionally, eliminating too many foods from your diet can result in nutrient deficiencies, ultimately leading to more health problems. That means doctors appointments, procedures, medications to take – all of the results you were trying to avoid in the first place by taking a seemingly harmless home test. These tests market a solution to your suffering, but what you are really buying is more stress, confusion, and complicated mealtimes.

Other factors to consider…

Keep in mind that your headaches, stomach aches, GI symptoms, lethargy, and mental fog may have nothing to do with your diet. Many of these home tests market themselves as answers to general physical ailments like these. But there could be a lot of reasons you feel this way that aren’t food related. Stress from work, school, life, and major events like a global pandemic can cause you to feel less like yourself, especially when that stress is chronic. Additionally, sudden changes in lifestyle like staying at home most of the time and being less physically active can impair digestion. Sudden changes in diet can also have repercussions for your stool patterns, like an increase in fiber or caffeine intake. And, if you are having significant abdominal pain upon eating, it could be indicative of a more serious GI condition like an ulcer, an H. pylori infection, or gallstones.

What should I do instead to get to the bottom of my food issues?

If you think you are having an adverse reaction to food, the best solution is to visit your primary care physician or a registered dietitian. Your physician can refer you to an allergist to determine if you have an allergy based on clinical testing. Registered, licensed dietitians are the only healthcare providers who are able to effectively help you identify intolerances and navigate an elimination diet to narrow down any trigger foods you might have. Their goal is to find what bothers you without unnecessarily cutting out too many foods or even entire food groups.

I know that getting help from a dietitian seems like the long way to a solution and quick answers are much more attractive, especially when you’re in so much discomfort when you eat. Having digestive issues is not fun! But, think of working with an RD as “food therapy”. Working out what foods are bothering you and how to build your diet/lifestyle around that is going to take time. Anyone or anything that says otherwise should be approached with a healthy dose of skepticism. Just like you wouldn’t believe a mental health counselor who says they can cure your depression with one session, or a physical therapist that says they can relieve your pain with one exercise, or a doctor that says they can cure your cancer after just one appointment – don’t believe someone who says they can solve your stomachaches overnight.

http://www.carlehealthfitness.com/wp-content/uploads/2018/07/dietician.jpg