Placement update – Cow’s milk allergy in paediatrics

I made it through 12 weeks of dietetics placement – and well done to everyone else who has been on a work placement or internship this summer! That first taste of adult life and not having a huge uni summer stretching ahead of you is tough! But I have thoroughly enjoyed this summer, and it has been a big learning curve.

Working in such a wide range of dietetic specialities has given me the opportunity to see a variety of patients, from infants to teenagers, working-age and elderly adults. I think the area which I have progressed in the most is paediatrics – I wasn’t very confident about working with children initially. It’s such a varied area – I could be seeing new-borns all the way through to 18-year-olds. One of the main reasons for referral that I came across in paediatrics was cow’s milk allergy, which I have written a little bit about below.

 

Cow’s milk allergy

According to Allergy UK 2-3% of 1-3 year olds are diagnosed with cow’s milk allergy in the UK. It occurs when the immune system reacts to the protein in cow’s milk causing either an immediate reaction, or a delayed-onset reaction. The infants that we saw in clinic usually experienced a delayed-onset reaction, where symptoms tend to emerge after a few hours, days or weeks. Many of the babies show symptoms of vomiting, reflux, diarrhoea or constipation, tummy pains, eczema or rashes, among others.

The only way to check for sure that the above symptoms are caused by a cow’s milk allergy is to exclude all cow’s milk and dairy from the baby’s diet and see if the symptoms improve.

Babies with a confirmed cow’s milk allergy must follow a completely dairy free diet. This means using a specialised infant formula or, if the babies are breastfed, the mothers must also exclude dairy as proteins from the cow’s milk can pass through the breast milk and continue to cause symptoms. However, we then work with mothers to ensure that their diets are nutritionally adequate, particularly providing enough calcium.

We also explain to parents that children often grow out of a cow’s milk allergy, so in the future we would work with them to slowly reintroduce dairy back into their child’s diet to see if they are still allergic.

** (Lactose intolerance is different to cow’s milk allergy. Lactose is the sugar present in cow’s milk and our bodies use an enzyme called lactase to break this complicated sugar down so that it can absorbed. Some people have lower levels of lactase, but the levels of lactase fall gradually and naturally as we get older and drink less milk than when we were babies. If people have particularly low levels of lactase they find it difficult to digest the lactose in milk so can start developing symptoms such as diarrhoea, bloating, stomach pain and wind. However, lactose intolerance more commonly occurs in older children or adults – very rarely in infants.) **

 

For more info on any of the above, I have included a couple of resources below. Always remember to visit your GP or a dietitian for any dietary advice.

Allergy UK – https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/469-cows-milk-allergy

BDA Food Facts sheet on ‘Suitable milks for children with cow’s milk allergy’ – https://www.bda.uk.com/foodfacts/CowsMilkAllergyChildren.pdf

 

Image: pexels.com

Placement update no. 2

Before I started my placement this summer, a lot of friends and family were asking me what I would be doing in my day-to-day and, to be honest, I wasn’t really sure myself. Dietetics is such a varied job that until I started I didn’t know which areas of dietetics practice I would be working in. In reality, it has been extremely varied, especially working in the community as I have been working with different specialist dietitians each day and in different areas of the borough. Therefore, I thought I would give you guys an update on what I’ve been getting up to over the last week.

Monday

For the past couple of weeks, I have been working with a diabetes education group on a Monday. It is a whole day event that works with groups of about 10 newly diagnosed Type 2 diabetics. The topics covered during the day include explaining what diabetes is, its complications and various medications used to control it as well as dietary and physical activity information. It’s run by a diabetes nurse and dietitian, with a lot of participant interaction throughout the day.

For the last two weeks, I have been delivering the physical activity section of the day. I invite the group to share their experiences of physical activity and exercise as well as giving advice on the government recommendations and how to overcome barriers. (You can read more about physical activity in some of my earlier blog posts here.)

This group session has given me the opportunity to work with people from very different backgrounds, with diabetes of varying severity and a multitude of challenges in their daily life. It’s also taught me that I can give group presentations without getting nervous and that I’m actually sometimes quite good at them.

Tuesday

Recently, I have been accompanying a malnutrition dietitian on home visits. This has potentially been the biggest learning curve for me so far. Many of the patients are receiving nutritional support through a feeding tube (either because they can’t eat anything at all or because they are not managing to eat enough to sustain them). I across plenty of patients in hospital with a feeding tube on my previous placement, but when you see people in their homes, it becomes apparent what the realities, and difficulties, of living long-term with a feeding tube are.

The feed amount must be carefully calculated by the dietitian based on an individual’s energy needs (which can be very different for each person). People may also often need help to attach the bags or bottles of feed to their feeding tubes, and this is where family, friends and carers come in to play. Each person will also be on a very individualised feeding plan. For example, one may be fed through their tube only overnight, giving them the opportunity to eat and carry out more normal daily activities during the day, whereas others may need to be fed for longer periods throughout the day. Another thing that dietitians must consider when working out someone’s feeding regimen is their medications, as some must be taken on an empty stomach, and others are not.

When the dietitian visits patients at home they often check people’s weight, their appetite, current diet (if they are able to eat anything), and how they’re getting on with the tube.

Wednesday

On Wednesdays, I have been sitting in on and taking part in a general dietetic clinic. Here we’ve seen people who have been referred to the dietitian by their GP for a variety of reasons, the majority of which have been weight loss, oral nutritional support and IBS (irritable bowel syndrome). It has been interesting to work with a variety of conditions and has given me the opportunity to work on my consultation skills.

Thursday

I have been working as part of the adult mental health team on Thursdays, which so far has involved working with patients with dementia. Once dementia gets more progressive people often either forget to eat (so lose weight), or forget that they have already eaten (so gain too much weight). It often takes delicate management to help people with their diets, taking other lifestyle and health factors into account, as well as their dementia diagnosis.

Friday

So far, I have been working in paediatrics (with children) on Fridays. I have thoroughly enjoyed this, and learnt a lot about managing the diets of children with allergies or other health conditions. It has also been an eye-opener as I’ve realised that a consultation doesn’t always run smoothly when you are working with children! Being flexible and adapting to the child and their parents is essential. I’ve learnt to remember that you often need to factor in the whole family’s diet and lifestyle as no child ever wants to be singled out as different. However, something that the paediatric dietitians have reiterated is that you often get to work with families for a long time and see these children grow up.

I think that is one of the biggest things that I have enjoyed so far about working in the community – you often work with people for a long time, so are able to build a rapport with them, and really see their progression.

 

I hope this post has given you a little insight into my experiences so far as a student dietitian. I may update you guys again a bit later on in the summer to let you know how I’m getting on!

Hope you have a good week.

x

First placement update

My first couple of days of placement have been busy but luckily not too long so far – although I’m sure that is set to change soon. This week I’ve been doing various inductions (including IT training – yay!) and shadowing a few dietitians.

So far, I have only got involved in taking diet histories of the patient as part of the initial consultation. This entails me asking the patient to describe a typical day’s food and drink in the context of their usual routine. I may then focus in on certain aspects of the diet history that might be important. For example, I may ask an IBS patient a little bit more about their caffeine intake and their stress levels as these are particular triggers for many people with the condition. A detailed diet history enables the dietitian to understand current food habits and lifestyle, not just so that we know what to improve on, but also so we can get a greater understanding of the patient’s day to day life. (There’s no point making a suggestion or recommendation that the patient has no chance of implementing.)

 

Being on placement out in the community this summer means that I am doing a lot of walking and catching various buses. Luckily, I’ve got a couple of things which are making my life much easier whilst I’m on placement.

Trainers

I have finally accepted (after years of blisters) that it’s essential for me to have comfortable shoes to walk around London in. It does mean that I need to take work shoes with me, but I’m happy to go to that effort to be able to power walk with ease!

Music & Podcasts

My commute/walk to most of my sites is about an hour to an hour and a half so I listen to my favourite songs or podcasts on my way.

I even went so far as to make a playlist of my current favourite tunes to listen to at the moment on Spotify: https://open.spotify.com/user/1138014904/playlist/6HUiSAs6iEw63Cb42h8W7E

A few of the podcasts that I have been listening to recently include:

The One Girl Band Podcast with Lola Hoad

BBC Radio 4 Woman’s Hour (especially interesting in the lead up to the election)

Don’t Salt My Game with Laura Thomas, PhD

Letters to My Fanny – Cherry Healey (I think Cherry is on a break from doing podcasts at the moment but her old ones are absolutely hilarious and definitely worth going back to listen to!)

Diary

I still much prefer using a paper diary to my phone, and I don’t know where I’d be without mine at the moment! I’m also a complete sucker for beautiful stationary – I got my silver diary from kikki.K (in the sale, though).

Lunchbox

Very unglamorous, but essential! There aren’t always places for me to buy food at the different placement sites, but it also saves me a lot of money to make packed lunches. Why don’t you check out my previous blog posts on meal planning and salad inspiration for some tips and ideas?

 

I’ll try to keep you guys posted on how I’m getting on during my placement throughout the summer. I know you guys will understand that I will never divulge details about where exactly I am working or any specifics about the consultations to ensure that I maintain complete patient confidentiality. But I am very happy to share what I’m learning about dietetics as a profession and my own personal development.

 

Have a good rest of the week!