Pediatric Nutrition: Serving Infants and Toddlers Who Need a Little Help
Everyone needs proper nutrition to thrive, but when a baby or toddler encounters feeding difficulties, how can parents and their pediatrician overcome those challenges? One answer is the developmental clinic at The Women's Hospital. Abby Ungetheim, dietician and nutritionist, explains what the clinic has to offer and who might be a good candidate for the clinic’s services.

Multidisciplinary Team Expertise
Infants and toddlers seen at the clinic are at an increased risk for developmental delays and feeding and growth difficulties due to a number of factors. The developmental clinic is a multidisciplinary team of specialist who are educated and trained to follow high-risk and medically complex infants and toddlers. Comprising the developmental team is a nurse practitioner, occupational therapist, and registered dietician. We monitor these infants throughout their first two years of life to ensure they are growing and developing on track.

Who Is Eligible for the Clinic?
Perinatal levels of care have specific criteria for automatic referrals to the developmental clinic. For example, a nutritional diagnosis that results in an automatic referral would be any infant with a birth weight of 1,500 grams or less, which is three pounds five ounces or below.

Any other high-risk infant who is deemed to have an increased risk for feeding difficulties, growth failures, or developmental delays can also get referred.

The Women's Hospital has a NICU discharge specialist to help ensure babies do not fall through the cracks. At NICU discharge, the physician places a referral to the developmental clinic, but we also receive outside referrals from pediatricians who may have a little one with concerns. 

The clinic sees many infants a month after NICU discharge; specifically if they have feeding or growth concerns. Otherwise infants are seen at four, nine, 12, 18, and 24 months. If the infant is premature, we will see them at their corrected ages, which is the age the infant would be. If they were born on their due date, we then follow the infant until they're no longer corrected at two years of age. 

Treatment Protocols
When a child is referred to the clinic, the initial appointment lasts approximately 45 minutes. Parents fill out a questionnaire, which is a developmental screening tool for communication and fine motor skills. The nurse practitioner, occupational therapist, and registered dietician are all present at the same time for the baby's assessment and evaluation.

The occupational therapist plays with the little one to assess their development, and the nurse practitioner does a physical assessment. From a nutritional perspective, the dietician reviews growth trends for height, weight, and head circumference.

Then, the team discusses growth charts with parents and assesses needs for catch-up growth. They review the child’s current feedings to ensure their needs are being met. At the end of the visit, every team member comes together to address any parent concerns and provide recommendations if further interventions are needed.

Identifying Next Steps
Many of the infants seen at the clinic require higher caloric and nutrient needs due to a number of factors. At the first appointment, it's important for the dietician to assess the infant's home feeding regimens to ensure they're growing and meeting their calorie protein and nutrient needs.
Some questions asked include:

• Has the infant been diagnosed with failure to thrive?
• Is the infant struggling with reflux or constipation?

The dietician can help with reflux precautions and strategies to lessen the symptoms of constipation.
Depending on the situation, we may even recommend adjusting to a different formula to achieve better feeding, tolerance, and growth. At our 12-month visit, the dietician will look at table food intake, and it's important to assess quantity and variety of table foods to determine if their needs are being met. If so, we will discuss how to transition from formula or breast milk over to whole milk. 

If infants are not doing well with table foods at this age, the dietician can help determine if a toddler formula or supplement is needed to help meet their needs. “If their growth is slow, but they're doing well with table foods, we can discuss ways to increase calories with table foods alone. 

Early Intervention Is Key
Every infant and toddler seen at the developmental clinic is at an increased risk of developmental delay or growth failure. So, early intervention is so key. Being able to evaluate these infants at their different ages from a developmental and nutritional perspective can help the infant reach their best potential.

This is crucial, because nutrition has such a major impact during the first two years of life. It truly serves as the foundation for their development. For example, if you have an infant who is experiencing growth failure, they may not have the energy to meet developmental milestones such as rolling, crawling, or walking.

Thankfully, the clinic team does everything in their power to make sure pediatric patients reach their growth goals. It is so amazing to watch an infant come to us right after they leave the hospital and then to see them at two years old, to see the growth that happens.