We’ve heard you loud and clear!!! One of your biggest challenge as a pediatric dietitian is staying up-to-date. So here’s a roundup of new resources, tools and evidence to update your practice.
# 1: Nutrition Management of Term Infants with Growth Failure
Regardless of which area you work in, you’re bound to encounter children with growth failure.
This 2-pager developed by the American Society for Parenteral and Enteral Nutrition (ASPEN) was just released a few months ago. It goes through key concepts of defining pediatric malnutrition and shares a consensus-based nutrition pathway complete with specific energy and protein targets for catch up growth all the while highlighting common challenges that you might face when feeding infants with growth failure.
You’ll definitely want to add this one to your cheat sheet collection!
LINK for the fact sheet Infant Growth Failure Factsheet
For more information on pediatric malnutrition and catch up growth, check out our blogs:
Mid-Upper Arm Circumference in Pediatric Malnutrition
Pediatric Malnutrition – Dietitians Make a Difference
Catch Up Growth in Infants – Tips to Help Set Your Goals
# 2: Clinical Guide to Probiotic Products in Canada and the USA
One of the most common questions we see repeatedly in our FB group: Pediatric Dietitians: Newbies to Masters, “is there any evidence that probiotics can help this condition, and if so, which one do I recommend?”
The 2022 Edition of Clinical Guide to Probiotic Products Available in Canada and in USA is now out. This one tool is such a game changer. Their website or app allows you to make clinical decisions on appropriate probiotic use, by allowing you to filter for pediatric patients, conditions where there is evidence for probiotic use, helping you select the appropriate product, dose and formulation.
LINK for Canada Probiotic Chart Canada
LINK for USA Probiotic Chart USA
# 3: Early Gluten Introduction and Celiac Disease in the EAT Study
Building on the evidence of early introduction of solids to prevent food allergies, the Early Gluten Introduction and Celiac Disease in the EAT Study looked at the risk of developing celiac disease when wheat is introduced early.
This 2020 RCT found no cases (0%) of celiac disease with the early introduction group (4 months of age) vs. 7 cases (1.4%) with the standard introduction group (6 months of age) (N= 1004) by age 3.
The Canadian Celiac Association has since made this statement: “Altogether, the results […] demonstrate that early introduction of gluten at 4-6 months does not increase the risk of celiac disease later in life, appears to be safe and may well actually decrease the risk of developing celiac disease.”
LINK to full article: Early Gluten Introduction and Celiac Disease in the EAT Study: A Prespecified Analysis of the EAT Randomized Clinical Trial
# 4: New Evidence in Oral Immune Therapy in Children with IgE Mediated Allergies
As Dietitians, we don’t often get to participate in oral immune therapy (OIT) for children with IgE mediated allergies, as these are done by allergists, however, it’s important to keep up with the evidence to better support our patients.
Two landmark articles on the efficacy of OIT in children with IgE mediated allergies were recently published: Chomyn et al, Clin Immunol (2021) on milk and egg allergies, and Jones et al, Lancet (2022) in peanut allergy.
The rate of outgrowing milk and egg allergy decreases over time, such that only ~50% of children outgrow their allergy by 5-6 years of age. Chomyn et al propose food ladders, a step-wise introduction of the allergen at home, as a method to promote tolerance in those who would naturally outgrow their allergy over time, or as a form of modified OIT in those with persistent allergy as an effective tool. If you practice in Canada and envy Europe’s milk and egg food ladders, check out Chomyn’s adapted ladders to the Canadian diet.
Jones et al did a randomized, double-blind, placebo-controlled study, where participants with a peanut allergy were randomized to receive peanut OIT or placebo for 134 weeks. They found increase desensitization in the group who received peanut OIT before age 4, highlighting an opportunity for intervention at a young age.
LINK to full article: Canadian food ladders for dietary advancement in children with IgE-mediated allergy to milk and/or egg
LINK to abstract: Efficacy and safety of oral immunotherapy in children aged 1–3 years with peanut allergy (the Immune Tolerance Network IMPACT trial): a randomised placebo-controlled study
# 5: Transitioning From Nasogastric Feeding Tube to Gastrostomy Tube in Pediatric Patients: A Survey on Decision-Making and Practice
Have you ever wondered when children should be transitioned from a nasogastric feeding tube (NGT) to a gastrostomy tube (GT)? Faced with a lack of evidence, our very own Julie Larocque and colleagues from the ASPEN Enteral Nutrition Task Force Pediatric Work Group surveyed ASPEN members practicing in the US and Canada to better understand time frames, parameters, and decision points to guide families and pediatric clinicians.
Time to change an NGT to a GT ranged from 6 weeks to 12 months, with the most common being 3 months. Common factors taken into account included the child’s age, prognosis on the ability to feed orally, whether or not progress was being made on oral feeding and the clinicians’ willingness to proceed with the intervention. Caregivers’ preference to continue with a NGT was also considered a strong barrier to proceeding with a GT placement.
You can check out their consensus-based decision tree the next time you’re unsure whether you should be transitioning from an NGT to a GT.
LINK to full article: Transitioning From Nasogastric Feeding Tube to Gastrostomy Tube in Pediatric Patients: A Survey on Decision‐Making and Practice
LINK to decision tree: Pediatric NGT to GT Decision Making
Hit reply and let us know if any of these update your practice!
Charlene and Julie
P.S. Still have questions around growth failure and/or introduction of highly allergenic foods? If you’re interested in learning more about infant nutrition, join our wait list for our flagship course: Infant Nutrition Essentials.