Page 39 - Spring2012

A Dietitian's Experience

In a chIldren's psychIatrIc hospItal
By Kim rodriguez, Ms, rd, ld

The number of children’s psychiatric hos- implement genuine nutritional therapy for these
pitals in the U.S. is growing (www.ushosptial. children.
info). I am the clinical dietitian of a children’s If a diet instruction is performed, it must
psychiatric hospital in Georgia. This hospital be ordered by the physician. Only one diet in-
treats eighty children and is always full with struction has been requested in my three years
a waiting list for admission. Approximately of working at this facility, despite the fact that
86 percent of admissions are boys; 92 percent most of the children eat horribly and many are
are African-American, and 65 percent are re- morbidly obese. That single diet instruction had
admissions. Medicare and Medicaid pay for all been ordered for a lowfat, low-cholesterol diet to
admissions. “lower cholesterol” in a thirteen-year-old patient
taking a statin drug.
DIAGNOSIS AND TREATMENT Most physicians believe that diet changes are
The hospital provides psychiatric and mental not important, especially if the patient returns
health treatment for mood, behavior and anxiety to a home environment where the family cannot
disorders for children and adolescents between provide proper foods because of financial stric-
the ages of nine and seventeen. Some of the tures or other reasons. The hospital’s treatment
children have committed crimes and are too plan is wholly based upon, and reliant upon,
young to be imprisoned. Most are diagnosed with pharmaceutical intervention. Changing dietary
“conduct disorder,” which means that their par- habits is not, and never was, a part of the treat-
ents are unable to manage them. Other children ment plan.
have disorders manifested from family neglect Based on an actual patient, a typical diag-
and abuse. At times the hospital seeks to place nosis and treatment plan for a sixteen-year-old
children in a group or foster home following African-American male might look like this:
therapy.
Other psychiatric diagnoses might include DIAGNOSIS: Most
anxiety, ADHD, mental retardation, chronic Bipolar physicians
fatigue, substance abuse and self-mutilation. ADHD believe that
Medical diagnoses include diabetes, hyperten- Mild mental retardation (low IQ)
sion, and hyperlipidemia (high cholesterol and/ Oppositional/defiant behavior diet changes
or triglycerides). Most children present with Depression: two past suicide attempts are not
multiple diagnoses. Hypertension important,
My job responsibility at this facility is to Hyperlipidemia
complete an initial assessment of each patient, Morbid obesity: especially if
addressing special diet orders written by the Height: 64 inches, the patient
physician. I evaluate blood levels, if test reports Weight: 242 pounds returns to a
are available, for vitamin deficiency. I am ex- Body mass index: 41
pected to recommend lowfat diet protocols for home where
hyperlipidemia and monitor weight trend during TREATMENT: the family
the hospitalization. I feel that the true reason a Lipitor – high cholesterol cannot provide
dietitian is employed at most facilities is to meet Clonidine – blood pressure, ADHD
state guidelines for reimbursement rather than to Lithium – bipolar, depression proper foods.
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