Pediatric Nutrition at UF&Shands: Innovation and Excellence from Birth to Adolescence

A Special Message from Scott Rivkees, M.D., Chair of Pediatrics

A child’s nutrition is as essential and important as the air he or she breathes. Pediatric nutritional needs differ from adults, as children need extra calories for growth and activity, with young children needing up to three times more calories per pound than adults. Pediatric food preferences and eating patterns also differ from adults, with younger children favoring calorie-rich food eaten frequently. We increasingly recognize that pediatric nutrition influences long-term eating habits as well as the potential for obesity. We see that many external factors influence diet, including media, children-specific marketing by food companies and the widespread availability of fast food and junk food. Children swim in a world of calorie-rich beverages, including popular sports drinks, and some children will take in more than 30 percent of their calories from beverages.

We also recognize that sick children have unique nutritional needs that require special attention.

At UF&Shands, we have nationally leading programs that focus on the special nutritional needs of children. These recognized programs begin at birth and continue through childhood and adolescence in primary care. We also have custom nutrition programs for ill children to meet their special needs when they are hospitalized and at home.

The University of Florida Center for Breastfeeding and Newborns

The benefits of breastfeeding are well-recognized, as breastfed babies have less infections and lower rates of obesity at older ages than non-breastfed babies.

The University of Florida Center for Breastfeeding and Newborns, or CBN, was founded in 2008. Its mission is to improve infant health by increasing chances for successful long-term breastfeeding through parent and professional education and expert clinical care, as well as advocacy for the rights of breastfeeding families both in the hospital and after discharge to the home. The center models effective, efficient and family-centered medical care in the early newborn period and utilizes evidence-based care to provide support to all families, with special emphasis on the most vulnerable who are born into poverty or prematurely. The center provides a venue for provider training and clinical research.

The center has been supported by grants from Children’s Miracle Network, W. K. Kellogg Foundation, American Academy of Pediatrics and private foundations. Appointments are available five days a week at three different locations, improving access for patients and exposure to attending and resident physicians, the primary referral sources for the clinic.

Recently, UF&Shands was selected to participate in Best Fed Beginnings, a national quality improvement collaborative funded by the Centers for Disease Control and Prevention with a goal of improving breastfeeding through the pursuit of a “Baby-Friendly Hospital” designation. Through participation in Best Fed Beginnings, UF&Shands will establish infrastructure and processes, including an accurate method of tracking breastfeeding rates, which will allow success to be charted as the 10 Steps to Successful Breastfeeding are implemented. The CBN will be a key resource during this journey, providing education to the Best Fed Beginnings Team, staff, residents, faculty and patients, as well as for advocacy in the community.

Primary Care Initiative to Promote Healthy Eating

Healthy eating is an integral part of primary care at the University of Florida’s pediatric primary care practices. Healthy eating is a lifelong skill that is promoted from infancy through adolescence and into adulthood. With many overweight or obese children in the U.S. and Florida,we integrate healthy eating topics into every preventive care visit and many of our acute care visits.

We use age-based approaches in evaluating our patients and educating our families about healthy eating.

Drawing on the resources available through Bright Futures from the American Academy of Pediatrics, we reinforce the concepts of timely well-child checks to monitor growth and development. Using electronic health records, we follow changes in height, weight and body-mass-index, or BMI, in all children age 2 and older. This routine practice allows us to identify and treat children who may be underweight or overweight. We also develop and recommend age- and condition-appropriate nutritional approaches. For example, infants under 6-months of age should not start solids, whereas toddlers should only take in up to 16 ounces of milk a day.

We also implement the “5-2-1-0 Healthy Kids Countdown” recommendations for all families in an effort to systematically and consistently advise families on how to implement, model and teach healthy eating. This program seeks to help kids live a healthy lifestyle by asking them to do four simple things: 1) eat five fruits or vegetables per day; 2) limit screen time on TVs and computers to two hours or less per day; 3) get one hour or more of physical activity per day; and 4) drink zero sugar-sweetened beverages per day.

Importantly, our approach to facing the nutritional demands of our patients requires a combined multidisciplinary and community-based model of care. We are proud to partner with academic colleagues in breastfeeding medicine, adolescent medicine, nutrition and fitness through a specialty clinic for children with weight issues and endocrinology to address our patients’ specific nutritional needs. We are also actively involved with our community partners in addressing the rising nutritional needs of our families, including Women Infants and Children, the educational system (with emphasis on healthy school lunches) and local health clubs, which offer free summer memberships to adolescents. Lastly, we continually seek new ways to improve healthy eating in our patients.

Shands Hospital for Children at UF Nutrition Services

What’s the largest dinner party you have hosted – 10, 12, maybe 16 people? Consider serving approximately 1,600 meals every day. That’s how many patient meals are prepared and delivered daily by the Food and Nutrition Services Department at Shands at the University of Florida. This adds up to 1.5 million meals a year, including tens of thousands for children.

To provide superb nutrition for hospitalized children, we stand among a small group of leading hospitals that provide all fresh vegetables, cage-free eggs and sustainable seafood. The regular diet contains less than 35 percent dietary fat and sodium content is limited.

Pediatric patients at Shands Hospital for Children at UF have a selective menu featuring kid-friendly, healthy foods, which is especially important, as many children lose their appetite or stop eating when ill, which can impede their recovery.

Diet is not only a part of treatment but may sometimes be the treatment. Many children have special dietary needs that we address through daily consultations with dietitians. For example, some children with cystic fibrosis and other conditions may need 5,000 calories a day. Thus, offering calorie-dense foods, double portions and snacks may help these patients thrive. Or, children with cancer may have days of poor appetite and the next day may want pizza, macaroni and cheese or a simple bowl of chicken noodle soup, all of which are available daily. Ensuring children have input in their meal choices is also important, so patients and/or parents are asked to select meals.

While children are hospitalized, registered dietitians work with physicians and families to optimize nutrition. Parents may need help with issues such as how to properly prepare baby formula and how to better understand and implement healthy eating. Registered dietitians can be a resource in helping address these issues.

We recognize that children are not just small adults when it comes to health care. We also need to recognize that children are not small adults when it comes to diet preferences and nutritional needs. Through our specialized food services program, we ensure one of the best pediatric nutrition programs in the U.S. And we are making what we do better every day!