Tegan Medico, MS, MPH, RDN, CNSC: Diet and Nutrition Management in Pediatric Gastric Disease

The interplay between clinical and behavioral specialists, clinicians, and other stakeholders—let alone the parents and guardians—of pediatric patients with chronic digestive disease—cannot be overstated. Put simply: for best outcomes, collaboration is a necessity.

In an interview with HCPLive during the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) 2023 Annual Meeting in San Diego, Tegan Medico, MS, MPH, RDN, CNSC, of the department of pediatric gastroenterology, hepatology and nutrition at the University of Virginia School of Medicine, discussed the synchronizing strategies of clinical intervention and nutritional planning.

One easy example is the need to consider the method of treatment administration.

“Medications can impact nutritional considerations in a number of ways,” Medico explained. “Some of them impact energy expenditure. Some of them interfere with nutrient metabolism, and some of them can interfere with nutrient absorption. And oftentimes, the forms that medications come in—whether they're liquid or a tablet, can be highly osmotic and induce diarrhea. They're almost as osmotic as laxatives. So those are really important things to think about when you're evaluating your patients.”

Medico additionally discussed optimization of diet and nutrition support during pediatric patients’ rehabilitation—a strategy that in lieu of a comprehensively ideal guideline requires an appreciation for the individual.

“It starts with knowing your patient's anatomy and tailoring their nutrition interventions to that. A lot of it becomes trial and error,” Medico said. “But again, it's doing a careful assessment and really knowing your patients.”

Regarding goal-setting, Medico recommended her peers begin with the patients’ parents and guardians—establishing what their priority for their child and the family in general as it relates to their digestive disease can provider clearer paths of care.

“A good example of that might be increasing oral intake,” Medico said. “I think, at least from our team, we always keep that as a goal. We want to avoid the development and progression of pediatric feeding disorders, which are pretty common in this population. And oftentimes, that is a goal of the parents: they want to see their children eat. But every once in a while, it's not.”

Medico also reviewed the transition of care from pediatric to adult gastric disease care, and how the specific components of diet, nutrition and clinical disease management can become the ownership of a maturing adolescent. The concept is pivotal in the care process, but is lesser-researched currently.

“We know it's really important; we probably don't do a very good job of it,” Medico said. “But one thing that I think a lot of people agree on is that it starts early. You have to start involving the kids in the conversations about what's going on with them early. And I I think we're still figuring that out.”