Clinical Nutrition Month Celebrated at Blythedale Children's Hospital

Blythedale’s Clinical Nutrition team provides medical nutrition therapy to each patient and resident, closely monitoring progress to ensure each child grows and thrives.

Brooke Kealey, RD, LDN, Clinical Dietitian and Leslie Heineman, M.S., R.D., C.L.C., Clinical Nutrition Manager at Blythedale, look individually at every patient and resident, and assess them weekly according to the guidelines set in the Academy of Nutrition and Dietetics’ Nutrition Care Manual.

“The Nutrition Care Manual entails medical nutrition therapy,” said Kealey. “In medical nutrition therapy we monitor anthropometrics such as, weight, height head circumference as well as dietary intake and the amount of formula they’re intaking, as well as their growth.”

Heineman added, “For every patient, we need to make sure they’re getting adequate macronutrients and adequate micronutrients that support growth, but also what they can tolerate.”

Tolerance is an important factor because of the Hospital’s medically fragile population. 77% of Blythedale’s patients do not receive their nutrition by mouth and require tube feeding, via a G-tube, NG-tube, or a G/J-tube. Additionally, some patients are on parenteral nutrition, receiving their nutrition through their veins.

“If you think about it, whether you eat a small meal or a large meal, it’s all going down into the stomach and the stomach can manage that but the intestines are so much smaller and so it cannot take on that volume,” said Kealey. “It’s very important for us to assess these tolerances and if necessary, feed these babies and children continuously with formula, every single hour, in small amounts.”

The dietitians also assess patients based on their medical diagnoses.

“Our patients often need non-traditional pediatric formulas that are specifically designed for their metabolic needs, and we also can work with the medical team in a way that suits their needs,” said Heineman.

For the medically complex population at Blythedale, the dietitians work to individualize each need and collaborate closely with the clinical teams. 

“We see infants who are NICU graduates that need to wean off a ventilator and need to gain weight,” said Kealey. “Prematurely born babies may have immature lungs, which can cause difficulty breathing and sucking and swallowing, so they may need assistance because they are building their stamina to do so.”

The team also treats patients who have short bowel syndrome due to necrotizing enterocolitis (NEC), as well children who have sustained a traumatic injury.  

“When they come to Blythedale, it’s really about medical nutrition therapy to make sure that they are getting adequate nutrition and hydration, and gaining and growing,” said Kealey. “For our older population, it’s also an opportunity for us to work with them to educate them about healthy nutrition to hopefully build upon skills of eating and bring that home with them for lifelong health.”

“When someone has a brain injury, they may lose function and that could be that they have trouble walking, said Heineman. “But it could also mean that they have trouble swallowing and that’s a big concern because if you cannot chew and swallow your food, there’s a risk that you can aspirate, which means some of the food that you are taking in could go in your lungs and that’s a real threat.”

Once a patient is ready to discharge, Kealey and Heineman, work with the parents and families to provide education tailored to each patient’s needs.

“A lot of our patients go home and it’s not just the recipe that’s on the back of the formula can,” said Heineman. “Although that might be appropriate for most kids, our children may require higher calorie concentration to promote growth. We educate parents on these specialized formulas because it is so important that the families comprehend how to make them.”

Kealey and Heineman reflected on what they love the most about being a nutritionist.

“That’s an easy one,” said Kealey. “Being around kids all day - babies, toddlers, school-aged, teenagers - just makes the day go by with joy and laughter and happiness. I love working with the patients and families to set them up for success at home. Overall, I love the relationships you get to make with the children and families.”

Heineman said, “People will say to me, it must be sad working at Blythedale, and I don’t feel sad when I’m around our patients. I know they’re going through some very difficult and trying experiences, but we see the joy that comes with successes. It’s very rewarding and it’s a happy place to work.”