1. What is a dietitian?

In Canada and Australia the dietitian role is a regulated role. Dietitians hold a Bachelor’s degree in Human Nutrition and Dietetics and then must complete supervised practical training before writing an examination. Dietitians can work in a variety of community, education, industry and healthcare settings.

As dietitians it's probably not surprising that we love food and flavours and one of our favourite moments is mealtimes with family and friends. The art of cooking and the joy of sharing food is intrinsic in culture and society. In early development, feeding dynamics bond infant and mother, and set the scene for exploring tastes and textures. Then there is the nutritional aspect!

2. What do you like best about your role as a dietition in pediatric transplant??

We love that every day is different and presents a new challenge. We are fortunate enough to follow children from listing through their transplant journey and beyond, working with families to address concerns and provide education at each age and stage. Although we work in different areas (Louise in cardiac and Sheridan in renal) there are similarities as well as differences in the nutrition challenges for our patients. Intrinsic to our role as a dietitian is to encourage adventure with textures and flavours and to try to influence a positive enjoyment of food. Many infants and toddlers who are unwell prior to transplant may miss out on key feeding skills in the development of feeding as they often have poor appetites, reflux or intolerance. Mealtimes become a stressful experience. Children may then be extremely fussy or have a very limited range of foods they will accept. Helping families through this is so rewarding. We love to hear more about families’ food culture and eating practices and to encourage their empowerment in feeding their child.

Our role is supported by several other allied health professionals as we often work closely with occupational therapists/speech language pathologists around oral feeding as well as child life therapists, psychologists and social workers amongst others. Furthermore, we aim to create a seamless experience for families by liaising with community partners to support transition to a “new normal”. We are leaders in the provision of enteral and parenteral nutrition and use our expertise and practice based knowledge to ensure safety and quality and appropriate utilization of resources.

3. What are the challenges in carrying out your role as a dietition?

Every child and family is unique and requires an individualized approach to nutrition. Achieving adequate nutrition and growth for children requiring a transplant has many challenges with multiple dietary restrictions and often feed intolerance. Psychosocial factors add another complexity. Our clinical workload is challenging as the complexity of the patient population has increased over the years. Following patients in an ambulatory setting provides a certain unpredictability to the day, as unanticipated issues often arise! This makes it difficult to dedicate time to projects and research. Additionally, our diverse patient population and small numbers of cohorts, as well as the many variables in nutrition are a challenge in developing and conducting research.

4. Describe a routine day

It would be hard to describe a “typical” day, but that is what makes our role exciting! We follow patients from pre-transplant, when they may be very ill and hospitalized, though their post-operative period and beyond. We use a variety of communication approaches including in person, ambulatory clinic visits, phone calls and e-mails. With COVID-19 we have started to have virtual visits with families which can have advantages. For example, we can better assess how families prepare feeds or what foods they might offer as they can grab the product, bowl or cup from their kitchen and show us in real time!

One of the aspects we most enjoy about being a dietitian is the variety of work in a day – encompassing clinical ward rounds, calculations of feeds and nutrients to talking and listening and counselling families. We may conduct practical hands on education with cooking or label reading and are always in demand for new snack ideas!

A large part of the role of the dietitian is to interact with other team members to support and enhance the patient experience. We work closely with doctors, nurse practitioners and nurses to manage fluids and electrolytes and nutrition support. We work with child life specialists, speech pathologists, occupational therapists, psychologists and social workers to optimize oral feeding and provision of services when patients are discharged. Frequent multidisciplinary rounds keep us focused and allow for sharing of information, concerns and updates.

When time allows, we engage in committee work, such as IPTA as well as research.

5. What’s something you have found rewarding or are proud of that you have accomplished?

Louise Bannister:
My role as a dietitian is extremely rewarding. I often meet patients and families when their child is very ill and the topic of transplant is new and scary. I am fortunate enough to follow them post-transplant until they transition to adult programs. Seeing children and families grow and develop, often weaning off nutrition support and progressing to oral feeding is very rewarding.

I am very proud of the team approach we provide to patients and families. Each member of the multidisciplinary team is respected for the expertise they provide to optimize patient outcomes. We all work together, focusing on the goals of the family.

Sheridan Collins:
I love getting to know children and their families and feel privileged to share in their journey with feeding and nutrition. Creating interactive tools of education is an area of work constantly in progress to help children and young people develop a better understanding and enjoyment of healthy eating. Participating in and generating an effective and supportive multidisciplinary team culture is very rewarding.

6. How does IPTA membership add to your role as a dietitian in transplant?

The pediatric transplant community is small so membership in IPTA allows for networking, education, information sharing and collaboration. IPTA is a unique organization that has a strong focus on pediatrics but also emphasizes the role and contributions of allied health professionals. The biannual conference includes programming targeted specifically towards allied health professionals and provides a forum to share research and highlight the contributions of the multidisciplinary team. Meeting and networking with other dietitians and health professionals through IPTA is exciting and enlightening. IPTA conferences present a great opportunity to learn from other centres about their approach in optimizing care in pediatric transplantation. Opportunities for collaboration in presentations and partnering on research may develop from IPTA networks. For example, we conducted a workshop session on a multidisciplinary approach to tube feeding and tube weaning at IPTA 2019 in conjunction with Soleina Maherali RD and Ashley Graham OT.

We recommend IPTA membership for all allied health practitioners working in pediatric transplant and would welcome your expertise and collaboration!