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Developmental Clinic/Nutritional Service for Pediatric Patients
Good nutrition is hard enough to come by in our own adult lives and often, it's even more difficult for our children. Abigail Ungetheim discusses the Developmental Clinic, how a baby gets referred to the clinic, the nutritional services offered for pediatric patients, and more.
Featuring:
Abigail Ungetheim
Abigail has been a Registered Dietitian at The Women’s Hospital since 2018. She has experience with developmental clinic, feeding clinic, and NICU. Her focus is on maternal health, infants, and toddlers. Transcription:
Deborah Howell: You know, good nutrition is hard enough to come by in our own adult lives. And often it's even more difficult for our kids. I'm Deborah Howell and our guest today is Abby Ungetheim, a dietician and nutritionist, and together we'll talk about the developmental clinic and nutritional services for pediatric patients at the Women's Hospital. Welcome Abby.
Abigail Ungetheim: Hi, Deborah. I'm so excited to be here. Thanks so much for having me today.
Deborah Howell: Are thrilled that you're in the house. So what is the developmental clinic at the Women's Hospital? And how did this service start?
Abigail Ungetheim: The developmental clinic at the Women's Hospital has expanded and grown as a result of the Women's Hospital, achieving their accreditation as a level three perinatal center in 2019. The academy of pediatrics had conducted a study that indicated states with levels of care certifications have lower numbers of infant and maternal deaths and illness. This means the Women's Hospital is equipped to care for complex maternal complications and care for those infants requiring needle natal intensive care.
As a result, the developmental clinic is a team of specialists, educated and trained to follow these high risk and medically complex infants and toddlers. The developmental team includes the nurse practitioner and occupational therapist and a registered dietician who are all overseen by a Neo. The infants and toddlers seen at the clinic are at an increased risk for developmental delays, feeding and growth difficulties due to a number of factors. We monitor these infants throughout their first two years of life to ensure they are growing and developing on track.
Deborah Howell: What an incredible mission, just, you know, I'm stunned by what you do every day. How does a baby get referred to the developmental clinic?
Abigail Ungetheim: The perinatal levels of care have specific criteria for automatic referrals to the developmental clinic. But for example, a nutritional diagnosis that would result in an automatic referral would be any infant with a birth weight of 1500 grams or less, which is three pounds, five ounces or below. Then of course, any other high risk infant that is deemed to have an increased risk for feeding difficulties, growth failures or developmental delays will get referred.
We have 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 for feeding difficulties, growth failures, or developmental delay.
Deborah Howell: All right. And Abby, at what ages do you see infants at the developmental clinic?
Abigail Ungetheim: We see many of the infants a month after NICU discharge, specifically, if they have feeding or growth concerns. But otherwise we see infants at 4, 9, 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.
Deborah Howell: Okay. And what happens once an infant gets to the developmental clinic?
Abigail Ungetheim: When you get referred to the developmental clinic, it's about a 45 minute appointment. When you arrive, parents are asked to fill out an ages and stages questionnaire, which is a developmental screening tool for communication gross and fine motor skills. A nurse obtains height, weight and head circumference. We then utilize a multidisciplinary team approach. Meaning the nurse practitioner, the occupational therapist, and the registered dietician are all present at the same time for the baby's assessment and evaluation. During the appointment, we pretty much just ask questions in play.
The occupational therapist plays with your 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. We then discuss growth charts with parents and we assess needs for catch up growth and review their current feedings to ensure their needs are being met. At the end of the visit, we all come together to address any parent concerns and provide recommendations if further interventions are needed.
Deborah Howell: I bet the parents are just so relieved to have this incredible team surrounding them and their child?
Abigail Ungetheim: Yes. It's great because we're all in there at one time and you can address so many different areas of parent concerns and you look at the little one as a whole.
Deborah Howell: Yeah. Yeah. And So what kind of nutritional services can a dietician provide at a visit?
Abigail Ungetheim: So the really unique thing about the developmental clinic is at each age, we see these infants or toddlers, there are specific nutritional aspects that we look for. Would you like to hear some examples?
Deborah Howell: I am all ears.
Abigail Ungetheim: Many of the infants that we see require higher calorie and nutrient needs due to a number of factors. So at that 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. Has the infant been diagnosed with failure to thrive? We can assess their estimated needs for catch up growth and increase the calories in their formula or breast milk to meet those needs to help them grow better. Or is the infant struggling with reflux or constipation?
The dietician can help with reflux precautions and strategies to lessen the symptoms of constipation, even 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. But if their growth is slow, but they're doing well with table foods, we can discuss ways to increase calories with table foods alone. So I have one last example for you.
Deborah Howell: Love to hear it.
Abigail Ungetheim: Some of the infants that we see are medically complex and they have NG or G tubes due to difficulty swallowing or unable to maintain adequate weight gain to medical diagnosis. So the dietician can help assess their feeding regimens, finding the right formula and the volumes needed and how to transition off tube feedings when, and if that time comes.
Deborah Howell: Okay. Now, if the developmental team has a nutritional or a developmental concern, what would be the next step?
Abigail Ungetheim: If there are any concerns of feeding or growth, the team may recommend the infant or toddler. See an outpatient feeding therapist to help with bottle feeding or table foods, along with an outpatient dietician to help monitor growth closely. If there are further concerns that may require a specialty doctor, such as GI, the nurse practitioner can refer them. Our NICU discharge specialist is familiar with resources in our surrounding areas and helps connect families with services close to their home.
Deborah Howell: That's lovely. And could you define what table food is for those who don't know?
Abigail Ungetheim: Sure. That would be foods like you and I eat. So, bananas, avocados, green beans, carrots, shredded chicken, ground beef, anything that you and I eat that a toddler might eat.
Deborah Howell: Okay. Sounds good. And what's the benefit in your opinion of evaluating these babies at such an early age?
Abigail Ungetheim: So every infant and toddler that we see over 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 these different ages from a developmental and nutritional perspective, can help the infant reach their best potential. Nutrition has such a major impact during the first two years of life. And it really serves as the foundation for their development. for example, if you have an infant who is growth failure, they may not have the energy to meet developmental milestones, such as rolling, crawling or walking.
A dietician can help ensure nutritional needs are being met. To meet those developmental milestones. So in summary, the overall goal of our clinic is to help catch developmental delays, feeding difficulties, and growth failure early at their two year graduation visit. We are hopeful. These toddlers are nutritionally and developmentally caught up to their peers. If not, we help ensure families are connected with the resources they need for their toddler to reach their best potential.
Deborah Howell: It must be incredibly rewarding at that two year point to see the babies become more like normal babies, and meeting those milestones.
Abigail Ungetheim: 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. It's amazing.
Deborah Howell: Well, this is some really good information. You do incredible work. Thank you Abby, for being with us today to talk about what you do at the developmental clinic at Deaconess. Really appreciate it.
Abigail Ungetheim: Of course, thank you again so much for having.
Deborah Howell: And that wraps up this episode of the podcast series from Deaconess the Women's Hospital, a place for all your life. To schedule an appointment or to learn more, please visit deaconess.com to get connected to one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Deaconess Women's Hospital podcasts. Two for more health tips and updates. Follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.
Deborah Howell: You know, good nutrition is hard enough to come by in our own adult lives. And often it's even more difficult for our kids. I'm Deborah Howell and our guest today is Abby Ungetheim, a dietician and nutritionist, and together we'll talk about the developmental clinic and nutritional services for pediatric patients at the Women's Hospital. Welcome Abby.
Abigail Ungetheim: Hi, Deborah. I'm so excited to be here. Thanks so much for having me today.
Deborah Howell: Are thrilled that you're in the house. So what is the developmental clinic at the Women's Hospital? And how did this service start?
Abigail Ungetheim: The developmental clinic at the Women's Hospital has expanded and grown as a result of the Women's Hospital, achieving their accreditation as a level three perinatal center in 2019. The academy of pediatrics had conducted a study that indicated states with levels of care certifications have lower numbers of infant and maternal deaths and illness. This means the Women's Hospital is equipped to care for complex maternal complications and care for those infants requiring needle natal intensive care.
As a result, the developmental clinic is a team of specialists, educated and trained to follow these high risk and medically complex infants and toddlers. The developmental team includes the nurse practitioner and occupational therapist and a registered dietician who are all overseen by a Neo. The infants and toddlers seen at the clinic are at an increased risk for developmental delays, feeding and growth difficulties due to a number of factors. We monitor these infants throughout their first two years of life to ensure they are growing and developing on track.
Deborah Howell: What an incredible mission, just, you know, I'm stunned by what you do every day. How does a baby get referred to the developmental clinic?
Abigail Ungetheim: The perinatal levels of care have specific criteria for automatic referrals to the developmental clinic. But for example, a nutritional diagnosis that would result in an automatic referral would be any infant with a birth weight of 1500 grams or less, which is three pounds, five ounces or below. Then of course, any other high risk infant that is deemed to have an increased risk for feeding difficulties, growth failures or developmental delays will get referred.
We have 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 for feeding difficulties, growth failures, or developmental delay.
Deborah Howell: All right. And Abby, at what ages do you see infants at the developmental clinic?
Abigail Ungetheim: We see many of the infants a month after NICU discharge, specifically, if they have feeding or growth concerns. But otherwise we see infants at 4, 9, 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.
Deborah Howell: Okay. And what happens once an infant gets to the developmental clinic?
Abigail Ungetheim: When you get referred to the developmental clinic, it's about a 45 minute appointment. When you arrive, parents are asked to fill out an ages and stages questionnaire, which is a developmental screening tool for communication gross and fine motor skills. A nurse obtains height, weight and head circumference. We then utilize a multidisciplinary team approach. Meaning the nurse practitioner, the occupational therapist, and the registered dietician are all present at the same time for the baby's assessment and evaluation. During the appointment, we pretty much just ask questions in play.
The occupational therapist plays with your 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. We then discuss growth charts with parents and we assess needs for catch up growth and review their current feedings to ensure their needs are being met. At the end of the visit, we all come together to address any parent concerns and provide recommendations if further interventions are needed.
Deborah Howell: I bet the parents are just so relieved to have this incredible team surrounding them and their child?
Abigail Ungetheim: Yes. It's great because we're all in there at one time and you can address so many different areas of parent concerns and you look at the little one as a whole.
Deborah Howell: Yeah. Yeah. And So what kind of nutritional services can a dietician provide at a visit?
Abigail Ungetheim: So the really unique thing about the developmental clinic is at each age, we see these infants or toddlers, there are specific nutritional aspects that we look for. Would you like to hear some examples?
Deborah Howell: I am all ears.
Abigail Ungetheim: Many of the infants that we see require higher calorie and nutrient needs due to a number of factors. So at that 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. Has the infant been diagnosed with failure to thrive? We can assess their estimated needs for catch up growth and increase the calories in their formula or breast milk to meet those needs to help them grow better. Or is the infant struggling with reflux or constipation?
The dietician can help with reflux precautions and strategies to lessen the symptoms of constipation, even 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. But if their growth is slow, but they're doing well with table foods, we can discuss ways to increase calories with table foods alone. So I have one last example for you.
Deborah Howell: Love to hear it.
Abigail Ungetheim: Some of the infants that we see are medically complex and they have NG or G tubes due to difficulty swallowing or unable to maintain adequate weight gain to medical diagnosis. So the dietician can help assess their feeding regimens, finding the right formula and the volumes needed and how to transition off tube feedings when, and if that time comes.
Deborah Howell: Okay. Now, if the developmental team has a nutritional or a developmental concern, what would be the next step?
Abigail Ungetheim: If there are any concerns of feeding or growth, the team may recommend the infant or toddler. See an outpatient feeding therapist to help with bottle feeding or table foods, along with an outpatient dietician to help monitor growth closely. If there are further concerns that may require a specialty doctor, such as GI, the nurse practitioner can refer them. Our NICU discharge specialist is familiar with resources in our surrounding areas and helps connect families with services close to their home.
Deborah Howell: That's lovely. And could you define what table food is for those who don't know?
Abigail Ungetheim: Sure. That would be foods like you and I eat. So, bananas, avocados, green beans, carrots, shredded chicken, ground beef, anything that you and I eat that a toddler might eat.
Deborah Howell: Okay. Sounds good. And what's the benefit in your opinion of evaluating these babies at such an early age?
Abigail Ungetheim: So every infant and toddler that we see over 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 these different ages from a developmental and nutritional perspective, can help the infant reach their best potential. Nutrition has such a major impact during the first two years of life. And it really serves as the foundation for their development. for example, if you have an infant who is growth failure, they may not have the energy to meet developmental milestones, such as rolling, crawling or walking.
A dietician can help ensure nutritional needs are being met. To meet those developmental milestones. So in summary, the overall goal of our clinic is to help catch developmental delays, feeding difficulties, and growth failure early at their two year graduation visit. We are hopeful. These toddlers are nutritionally and developmentally caught up to their peers. If not, we help ensure families are connected with the resources they need for their toddler to reach their best potential.
Deborah Howell: It must be incredibly rewarding at that two year point to see the babies become more like normal babies, and meeting those milestones.
Abigail Ungetheim: 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. It's amazing.
Deborah Howell: Well, this is some really good information. You do incredible work. Thank you Abby, for being with us today to talk about what you do at the developmental clinic at Deaconess. Really appreciate it.
Abigail Ungetheim: Of course, thank you again so much for having.
Deborah Howell: And that wraps up this episode of the podcast series from Deaconess the Women's Hospital, a place for all your life. To schedule an appointment or to learn more, please visit deaconess.com to get connected to one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Deaconess Women's Hospital podcasts. Two for more health tips and updates. Follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.