Pediatric Oncology Dietitian BY BRANDON L. LEE, TOIVO PASTO, TINA VEILSON AND ALYSSA RANSANICI

Part 1: What a Pediatric Oncology Dietitian is?

A health care professional who has special training in pediatrics (infants and children) and oncology (cancer) in the areas of food, nutrition,

biochemistry and physiology. Reasons an RD is needed: Children with tumors in the digestive tract are at risk of not getting

enough nutrients. Treatments like chemotherapy, radiation or surgery can cause nausea,

vomiting, diarrhea or constipation and poor appetite. Other additional effects of chemotherapy include chewing and

swallowing problems when the mouth, throat or esophagus becomes too dry or sore.

Radiation to the digestive tract can make it sore or keep it from working as well as it should.

How will the nutrition intervention of the RD help?

With the RD’s help the infant or child might/will: Better tolerate treatment and treatment side effects. Heal and recover faster. Have less risk of infection during treatment. Have better strength and energy. Do better at keeping up with normal growth and development.

What are the things a Pediatric Oncology Dietitian look for?

Pre-Diagnosis Growth parameters (head and abdomen circumference…) Growth velocity Lab values Gastrointestinal symptoms Taste changes Actual caloric intake

Common patient situations for Pediatric Oncology Dietitian's:

1. Nutrition by mouth- RD makes sure the child is eating and drinking nutrient rich foods and fluids, to keep a well balanced diet. If needed by the patient the RD will provide extra calories and protein meals, supplemented with snacks.

2. Tube feeding- The RD will prescribe the correct formulas to provide all calories, proteins, vitamins, minerals needed.

3. Vein or parenteral nutrition (PN)- A concern for an RD with patient on PN is that this method can be hard on the liver.

4. Child on steroids- The RD’s job is to prevent weight gain, fluid retention and high blood pressure. In addition an RD most of the time will suggest foods low in salt and drinks low in sugar.

End of Part 1: Things an RD will almost always come across in their patients in Pediatric Oncology:

Constipation Diarrhea Mouth pain, throat pain or mouth sores Trouble swallowing Nausea and vomiting Dry mouth or thick saliva Unwanted weight gain Fatigue Low white blood cell counts In Pediatric Oncology the care teams at minimum include medical doctors, registered nurses, registered dietitians and speech pathologists.

Part 2: What are the qualifications for being a Pediatric Oncology Dietitian?

Standard Requirements for RD1. Completed a minimum of a bachelor’s degree at a US regionally

accredited university or college and course work accredited or approved by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) of the Academy of Nutrition and Dietetics.

2. Completed an ACEND-accredited supervised practice program at a health-care facility, community agency, or a foodservice corporation or combined with undergraduate or graduate studies. Typically, a practice program will run six to 12 months in length.

3. Passed a national examination administered by the Commission on Dietetic Registration (CDR).

4. Completed continuing professional educational requirements to maintain registration.

Qualifications/ Credentials Continued…

Specialist Certifications Offered through Commission on Dietetic Registration Certified Specialist in Pediatric Nutrition Certified Specialist in Oncology Nutrition other certifications…

RD’s point of view and what to do:

Disease States and Nutrition Perform nutrition assessments and develop nutrition care plan for

specific disease states. Affects of cancer therapy in regards to nutrition

Variation in Assessment and Treatment No standard guidelines for assessment of nutritional state of children. Treatment of malnutrition also varies. Working with medical team to create treatment plan.

End of Part 2: Family Involvement/ Facilities

Patients and Parents Pediatric treatment involves parents as well. Ability to connect with children and young teens. Verbal skills to communicate with patients and parents.

St. Jude Children's Hospital Pediatric Oncology Education (POE) Program Clinical Nutrition Training Program

Part 3: What are the resources available to a Pediatric Oncology Dietitian?

Dietitians can join the Children’s Oncology group!

They are a National Cancer Institute that unites more than 8,000 childhood cancer experts at more than 200 top hospitals!!!

They had 100 active clinical trials open and they are aimed at understanding the biology of the disease and treatments.

This group also provides information on how to properly deal with patients and families.

They have 220 member institutions that help provide information about every aspect of the disease.

The American Cancer Society

The American Cancer society also provides information about childhood cancer and nutrition.

They help deal with nausea, steroid effects, and low white blood cell counts that all affect nutrition.

Offer recommendations of foods that do not have high levels of bacteria and can help the child fight infection.

End of Part 3: Practice group-Oncology Nutrition

Mission: To provide direction and leadership for quality oncology nutrition practice through education and research. National organization with over 2,000 members. The Practice of oncology nutrition covers research, prevention,

treatment, recovery, palliative care and hospice. Members work in clinical, public health, education and research

settings. Vision: Optimize cancer patients health and the prevention of cancer through nutrition. Values: Dedication, integrity, compassion and mentorship.

Sources:

www.cancer.org Date accessed: 11.1.13 www.stjude.org Date accessed: 11.1.13 www.cancer.net Date accessed: 11.1.13 http://www.childrensoncologygroup.org Date accessed: 11.6.13 http://www.cancer.org/treatment/childrenandcancer/whenyourch

ildhascancer/nutritionforchildrenwithcancer/nutrition-for-children-with-cancer-toc Date accessed: 11.6.13