Casey Napper, RD

PEDIATRIC DIETITIAN

for something nutrishus

I have had such a great response to the interview series, and am pleased that many local registered dietitians (RDs) have stepped forward. Today we feature Casey Napper. Like Casey, I too was intrigued by nutrition as a young athlete and wanted to work with sports, kids and adolescents (which I do). Casey has the tough job of tube feeding pediatric patients and seems to have found her dream job early on. She provided a great overview of her position, misconceptions of our profession, and being able to be a contributing team member.

Why did you become a RD? 

I knew I wanted to be in health care in some capacity, but wasn't sold on the hands on patient care of nursing (blood and needles are not my cup of tea, to say the least!) I was intrigued after a presentation by a sport dietitian as a young athlete, and after looking into the profession more, was interested in the variety of areas that a dietitian can work. I also love working with kids and adolescents, so I pursued nutrition hoping to one day specialize in either pediatrics, sports, or eating disorders.

What area of dietetics do you work in? 

I work as a clinical pediatric dietitian with the Saskatoon Health Region. Specifically, I cover the Pediatric ICU, and part of our Neonatal ICU.

How would you explain what you do?

In the PICU, children are admitted in critical condition, often needing the support of a ventilator to breathe, and often in a medically induced coma while they recover from their particular critical illness. Most are unable to eat orally during this time, and yet they are in need of optimal nutrition to support their recovery and meet the increased metabolic demands of their illness. My job is to ensure they receive optimal nutrition by way of tube feeding, and in some cases, total parenteral nutrition (TPN) or intravenous nutrition.

In the NICU, we deal primarily with preterm and low birthweight infants who need medical support to continue their growth and development in the outside world (that would have otherwise occurred in utero). I work in the less acute part of our NICU (another dietitian works full time in the more acute part), so my patient population is typically preterm babies who have been in NICU for a long period of time and are nearing their due date, and their discharge home. I also treat late preterm babies who need a bit of extra support for being born a tad early. Babies do not have the reflexes to suck, swallow and breathe with good coordination until they reach a certain gestation, so these babies need feeding tubes for nutrition until they are ready to start feeding my mouth, and to supplement their oral feeds while they are learning. As they get older and bigger, they start developing these reflexes and need tube feeds less and less. My job is making sure that these babies are getting the nutrients and calories necessary to grow and develop as if they were still in utero, so that they can go on to be happy, healthy children.

What are your ‘typical’ daily/weekly tasks? 

Each morning I attend rounds with the health care team. This includes the pediatric intensivist (PICU) or neonatalogist (NICU), medical residents, neonatal nurse practitioners, charge nurses, bedside nurses, and other important allied health professionals such as Respiratory Therapists, Social Workers, and Speech Language Pathologists. When daily reports are given and plans are made for the day, I contribute my recommendations for nutrition. I also do my part in educating medical residents and nurses on nutrition-related topics, as well as contribute to the larger clinical dietitian group at our hospital and within our health region.

What has been your career path? 

I realized after my internship, that my ultimate career goal was clinical pediatric nutrition. With a bit of good timing on my side, a temporary job opening in pediatrics happened to come about not long after my graduation, so I started my career on our inpatient pediatric ward. It was a wonderful place to learn and to really feel like a member of a team. Since then, I have also worked in pediatric outpatients, counselling babies discharged from NICU, general pediatric patients such as childhood allergies, failure to thrive, and new celiac diagnoses, and chronically tube fed children with gastrostomy feeding tubes. I also had the chance to briefly work on an adult Neurology ward, prior to my current position splitting my time between PICU and NICU.

What advanced education or special training do you have?

I was lucky enough to receive one-on-one training by an experienced pediatric dietitian for my first few months on the inpatient pediatric ward. Since then I have learned from other experienced colleagues, and from my own reading and studying on various pediatric topics. I have completed SOS (Sequential Oral Sensory) training, which is a program aimed at helping children overcome oral aversions and feeding difficulties. I hope to one day complete my Certified Nutrition Support Clinician (CNSC) designation through ASPEN (American Society of Parenteral and Enteral Nutrition).

In an ideal world, what does the industry look like 5 years from now?

Tough question! I can't seem to come up with a forward thinking, broad answer - I operate on a day-by-day basis in my job, I think I've become too comfortable with that process! But if I were to say something very specific to my area, I would say that using indirect calorimetry for measuring energy requirements in critically ill patients would be a goal.

What would you like people to know about RDs? 

One thing that often irks me in working in the clinical setting is being called 'dietary'. It seems it can't be shaken from the hospital lingo. It may be a simple request, but a dietitian is an educated individual with a 4 year degree, accredited internship, and specialized knowledge and experience under their belt. 'Dietary' is who fills the food trays in the kitchen, and delivers meals to the ward. There is a big difference!!! If you work with a dietitian, consider this before you refer to him or her as 'dietary'!

What do people think that you do for a living? 

When I tell people I'm a pediatric dietitian they often think that I counsel overweight or obese children on reaching a healthy weight. I find the public seems to equate 'dietitian' with 'weight loss.' This is most definitely not the case for my particular position, although there are certainly dietitians out there who are doing this important work. I think people are surprised at how much of my job entails non-oral feeding (tube feeds and TPN). These methods of providing nutrition are not something that an average person even knows exist. And it involves way more math than one would expect :)

What are you passionate about in dietetics?

Of course my number one priority is always the patient and helping them through their illness. It's so rewarding seeing a patient recover to a happy, healthy child after seeing them at their sickest. However if I were to answer in a different way, my favourite part about my job is the teamwork. I love being a valued member of a team, whether it is the medical team or the team of pediatric dietitians that I work with, or the team of allied health professionals we work so closely with. Collaborating and sharing ideas with my colleagues and patients' families, coming to a mutually agreed upon plan is one of the biggest reasons I am excited to come to work every day.

What makes RDs unique/different from other nutrition/wellness professionals?

Our degree and designation is not only measured in length of time spent (4 years), but also in the educational variety it encompasses. Not only do we learn in depth about all the various areas of nutrition (and related chemical, biochemical, and health sciences), but also are trained in how to interpret research, how to practice in an evidence- and science-based way, how to be a professional, how to practice ethically. We hold ourselves to very high standards, and are also held to high standards by our regulatory bodies.

What is your favourite meal? 

Greek Salad, no question!!

Thanks Casey!