To mark National Allied Health Professionals (AHP) Day 2024 (Monday 14 October 2024), Nicola Williams shares how she became a paediatric dietician working at Royal Manchester Children’s Hospital.
How did you become a paediatric dietician?
Initially I went to university to do Biological Sciences in Sheffield inspired by my favourite A level subject of biology. I wasn’t sure what I wanted to be at the time other than likely to do something with children and vaguely medical. During my course I chose to do a module in nutrition and only then learnt dietitians existed!
I thought this sounds ideal and promptly applied to do the post graduate course for dietetics. I went on to complete the course in Glasgow at masters level whilst working in my first clinical role in bonnie Loch Lomond.
I moved to Manchester for a full-time post at Manchester Royal Infirmary when I had completed my studies. I loved the department and moved up the grades. When I was a senior II dietitian (as we were called in those days!) I got to rotate into Paediatrics.
This confirmed what I always thought…Paediatrics was definitely for me. I applied to go to Royal Manchester Children’s Hospital as soon as possible!
Once at Royal Manchester Children’s Hospital, I rotated into haematology and oncology (blood and cancer) fairly quickly and was a bit worried it might not be for me but despite the very heavy case load I soon fell in love with the speciality. The patients and families are really something else and the whole multi-disciplinary team (MDT) works tirelessly together to offer the very best of care.
As a dietitian you are respected and empowered to lead on all aspects of nutrition for these precious little folk and young people going through the worst of times. The families/carers are receptive to your support and care and you are able to facilitate them to further look after their own child through diet and nutrition. Feeding and nourishing is such an important aspect of care for any child, but even more so here and in a situation where the parents may otherwise feel so powerless.
What unique qualities or skills do you believe are essential for your role?
To work as a dietitian in paediatric cancer care you need to obviously have understanding of normal growth in infancy and childhood, be able to competently assess the child and calculate requirements to formulate a dietetic care plan. But you also need an understanding of the conditions you will come across, the treatment protocols and the physical affects upon the child which will impact nutritional status.
Of course, you will also need holistic skills more than ever. These would include being an excellent communicator – especially a good listener, and of course the ability to always act with care and compassion, and to be patient and empathetic with the patient and their families/carers.
What is a typical day like as a paediatric dietitian?
A typical day could be going to the Bone Marrow Transplant Unit/ward and reviewing patients on treatment who are suffering gut compromise secondary to chemotherapy. They may require parenteral nutrition due to mucositis/vomiting and/or diarrhoea so calculation of requirements and advice on which bag and how much to prescribe – liaison with the pharmacy and medical team.
You may also see some patients weaning onto enteral nutrition and establishing tube feeds – getting naso-gastric tubes in situ can require some proficient explanation and negotiation skills with the patient themselves, especially older children or teenagers who can be terrified at the prospect. You then meet for handover with the MDT to go through all the in-patients’ issues and plans.
As the day goes on you may be completing notes at your desk, attending meetings, phoning patients at home for review or working on projects and service review for example. Clinic days are busy as all the patients come to see the consultant, specialist nurses and dietitian (it often feels like all at once!) so getting round everyone, checking weights, tweaking feed plans, giving out samples of supplements, answering queries about what patients can and can’t eat at the relevant stage of treatment can be full on but this is the best bit. The infant/child/young person is at home and doing better. They may have some complications and setbacks, but the majority are healing and recovering, and this is pure joy to be a part of. You can review your input and continue to support them going forward. You have the privilege of getting to know the families well and seeing their child thrive knowing you have been a part of helping that to happen.
Friday clinics are my favourite. These are for those further out of intensive treatment, this is where you can really see things getting so much better for these children and their families/carers – they need less input, and you are discharging them from your care but finally things are easier and more normal for them. They can tell you all the lovely foods they have been enjoying without the need for any nutrition support.
Do you have a story / example you can share from your role as a paediatric dietician? Patient feedback?
This year we collected data with patient reported outcome questionnaires. It was really rewarding to get the feedback we have received.
For example, 90% or more parents reported to agree or strongly agree that as a service we give advice tailored to lifestyle, provide reassurance and increase understanding in managing their child’s condition, treat people as individuals, enable confidence in choosing food for their children, make them feel we really understand their situation and most importantly improve the child’s well-being.
Recently some feedback has come through from a couple of families which I have supported which make me very proud.
“Nic, you are fantastic!! I hope you are told that often – you are an amazing dietitian – full of practical, sensible advice. Approachable, non-judgmental and you listened to our child, us and our concerns and really helped us and made a difference (HUGE!). Many thanks.”
“Nic has been brilliant with all the support! She was very polite and caring towards my child! Really appreciate the service she provided.”
What advice would you give to someone considering a career as a paediatric dietician?
If you are thinking of becoming a paediatric dietitian, you should totally go for it. You get to use science and translate it into practical and invaluable advice which can really impact the health and well-being of babies, kids, and teenagers alike. You should most definitely consider haematology and oncology too as a speciality within it to work in – I promise you would love it.
Of course, on occasion it can be desperately sad but the positivity, bravery, and courage you will see in the children and their families and the enthusiasm, encouragement and support you will have in your dedicated MDT will out-weigh that and give you heartwarming satisfaction in your role.