Family of Baby Mohamed during an event to thank the Sidra team.
A common challenge for many children with complex medical issues, including those with issues since birth is that they often experience feeding difficulties. This is where the role of paediatric dietitian can play a critical role in helping the families of such children to maintain a balanced nutrition programme, says Kim Underwood (pictured), a registered dietitian at Sidra.
“The nutrition status prior to surgery and nutrition rehabilitation after surgery can affect the child’s recovery process. If not assessed on time and in detail, there is the risk of additional complications and can impact the chances of survival. It is always important that a thorough nutrition assessment to identify patients who are at nutrition risk is done prior to surgery. This is so that their nutrition status can be optimised prior to the procedure and most importantly to minimise risks,” Underwood told The Peninsula.
At Sidra, experts work as an interdisciplinary team taking into account not only the child’s medical needs, but also their developmental and social needs and with the aim of supporting the family and child as much as possible. As part of a collaborative effort of the paediatric care offered in Qatar, teams from Sidra also on occasion work together with specialists from Hamad Medical Corporation.
“Effective communication amongst ourselves is vital both within the interdisciplinary teams at Sidra or with other healthcare doctors who have referred the patients to us. One way we do this is by having case conferences weekly where different disciplines — occupational therapy, physical therapy, case management, nursing, dietitians, social workers, respiratory therapists, etc. — meet to discuss children with complex medical issues and how we can work together to provide the child and the family all the support they may need,” says Underwood.
Dietician assessment at Sidra involves a full medical history with the dieticians assessing gastrointestinal symptoms such as vomiting, diarrhea or constipation, diet history, including current intake; appetite changes, feeding difficulties, which may include sucking, chewing, swallowing. They will also take biochemical evaluations where they look at blood tests and see how the liver and kidneys are working. They also assess deficiencies in any vitamins and minerals. Most importantly, dietitians review the child’s growth history (weight, length/height and head circumference) as these measurements over time show a child’s growth velocity / weight trends.
Underwood shared her experience with Baby Mohamed, who born with complex medical issues, and was her first referral at Sidra. “I met Mohamed when he was five months old and weighed just 4.9 kg. He always struggled with reflux and vomiting, so the feeds that he was getting were not staying down. He also had a nasogastric tube in situ — a special tube that carries food and medicine to the stomach through the nose.”
Under the care and supervision of the dietician team at Sidra, Baby Mohamed was kept healthy and strong and the team’s efforts supported his recovery from the several lengthy surgeries he had undergone to correct a specific set of malformations caused by his condition. As he will be required to undergo further surgeries in the future, Underwood and her team continue to closely follow his nutrition programme and development.
Underwood also said that, nasogastric tubes can be difficult for infants who often pull the tube out. “This form of feeding —although it seems invasive — can be life saving for many children with feeding difficulties. Sometimes an infant can become too tired to finish a bottle, (fatigue with feeding), some do not have good co-ordinated suck/swallow and this can result in the milk going into the lungs, known as aspiration leading to recurrent chest infections which can be detrimental to the child,” she added.
Underwood concluded by talking about the bond that dietitians end up forming with the families of the children. “Whenever I meet a family who has a child with complex medical issues, and given that they have already been through so much, I feel privileged and blessed that we will go on this journey of treatment and care together. I will have an opportunity to support and help the family through some tough times as well as tough decisions. We both work towards the same goal – for the child to get better and where possible fully recover,” she said.
