Experience working as a First Contact Dietitian and Primary Care Network Dietitian
Charlene Giovanelli-Nicolson
Central Norwich PCN
Nutrition Focus Area: Paediatric Nutrition
The following case studies are examples of patients that I have seen, which does not include their full clinical details, and is from reflection on the type of patients that have been added to my clinics as a Dietitian working in primary care.
Case Studies and Outcomes:
Case study 1 - CMPA
Follow up a child from 1 year of age, was diagnosed with CMPA, was on a hydrolysed formula. Was lost to follow up by the paediatric allergy dietitians. Worked on the milk ladder to broaden variety of diet. Stopped eHF, and switched to a plant-based milk alternative.
Was already an extremely picky eater, with a limited food intake, and poor weight gain.
First goal was to work through the milk ladder- after a few months, diary was added back the diet, and he passed the milk ladder challenges.
Explored sensory play, food chaining, visual meal planning, comfortable eating environment. Followed up and supported the parents often.
After a year, improved variety of foods, he was eating most family meals, and he caught up weight and was growing well.
All the above supported was provided at the GP practice, which made it easier for the parents to know how to contact me, and all support was provided in house.
Case study 2 - Malnutrition
14-year-old female, referred for disordered eating, was underweight and a picky eater.
Used SCOFF score, not an eating disorder, but underweight due to fussy eating and mental health issues, and not wanting to eat at school.
Started on an homemade nourishing drinks, food first in accordance to her perceived safe foods. Worked on expanding diet by encouraging her to be involved in family meals, meal planning, recipe development and to help cook foods that she likes eating. Requested bloods to ensure no nutrient deficiencies. All bloods were satisfactory. After 6 months of experimentation of new foods and recipes, regular meals and meals planning she was eating a more varied diet, was enjoying her food. Her nutritional status improved. She no longer required follow up appointments.
All support provided within the GP practice, and if any follow up support is required, and appointment can be made directly at reception.
Case Study 3 - CMPA
6-week-old baby girl referred for suspected cow's milk allergy, exclusively formula fed since birth. Doctor wanted input to see if I think it was CMPA. Doctor had started on eHF formula two weeks before. Symptoms still present, uncontrolled crying, poor growth, diarrhoea and rash. Decision not to do the diagnostic milk challenge due to symptoms not resolving on the eHF. Changed the milk to an amino acid formula and referred the baby onto the paediatric allergy clinic.
Case study 4 - Poor Appetite
4-year-old male, referred to dietitian for poor diet and appetite, and concern he was not growing. Weigh for Height (WFH) on the 25th centile, Height for Age (HFA) was on the 25th centile, and Weight for Age (WFA) were on the 50th centile. Weight was within the healthy range. His family were new in the country and were asylum seekers. The child was not familiar with certain foods, and was given biscuits, sugar drinks as compensation. Reinforced healthy eating, try to encourage less sugary foods and drinks due to oral cavities.