Children who have complex intestinal disease or who are failing to thrive benefit from new pediatric gastroenterology and nutrition clinical initiatives at American Family Children’s Hospital (AFCH)—initiatives that parallel the AFCH specialty’s improved ranking by US News and World Report.
Coordinated Support for Children with Intestinal Failure
The pediatric intestinal failure team, from left: pediatric surgeon Peter Nichol, MD, PhD; pediatric gastroenterology and nutrition division chief Luther Sigurdsson, MD; nutritionist Laura Bodine, MS, RD, CNSC, CD; and nutrition support pharmacist Susan Luskin, PharmD, RPh, CNSC, BCNSP.
In 2010, pediatric surgeon Peter Nichol, MD, PhD, and newly arrived pediatrics GI division chief Luther Sigurdsson, MD, launched a clinic for children with short-gut syndrome, severe intestinal failure, and other types of very complex intestinal disease.
Children who have these disorders are unable to eat by mouth or even receive nutrition though a gastric feeding tube. To survive, they require total parenteral nutrition (TPN)—nutritional formula administered intravenously.
Drs. Nichol and Sigurdsson are joined by collaborators from the AFCH nutrition and pharmacy services. During the team’s twice-monthly clinic, and through ongoing phone support, they work to optimize each patient’s TPN and minimize long-term side effects, which can include line infection or liver failure.
In 2011, the initiative expanded to AFCH inpatient units, where the team rounds daily. “We take a team approach to intestinal failure, which is the standard of care at major children’s hospitals,” Dr. Sigurdsson said.
As of July 2012, the team has provided inpatient TPN support for 300 patients, and provided outpatient care for 25 patients with intestinal failure.
Their ultimate goal, however, is to eliminate the patient’s need for TPN altogether. “TPN is a life-saving intervention, but it has many side effects,” Dr. Sigurdsson explained. “With active management, however, some children can come off TPN completely.”
A Systematic Approach to Failure to Thrive
The Failure to Thrive clinic team, from left: nurse practitioner Catherine Nelson, APNP; Dr. Sigurdsson; and nutritionist Shirley McCallum, RD.
Also in 2010, Dr. Sigurdsson, along with nurse practitioner Catherine Nelson, APNP, and nutritionist Shirley McCallum, RD, established a weekly clinic to evaluate, monitor, and treat children who are failing to thrive.
Failure to thrive can be diagnosed when a child, for a variety of reasons, does not gain weight according to the standard growth curve.
In clinic, the team first works to determine the underlying cause of the child’s poor weight gain. This may include an evaluation of caloric intake and eating patterns; an assessment of the social environment; and screenings for genetic syndromes, developmental delays, or congenital conditions.
The team then works to treat each child, collaborating as needed with specialists in nutrition, health psychology endocrinology, or genetics. Some children are also referred to the feeding team at the Waisman Center.
Dr. Sigurdsson and Nelson agree that the clinic provides patients with a clearer pathway for treatment. “We work systematically, and we’ve gotten very good at managing some of the behaviors that can be associated with poor feeding,” Nelson said. “It’s a multidisciplinary approach that results in better care.”