Fellowship Program Outline

The four- to six-month clinical fellowship program in Leadership Education Excellence in Pediatric Nutrition provides learning experiences that enable the dietitian/nutritionist to function as a specialist in the care of high-risk infants, children and adolescents throughout the continuum from acute hospital care to ambulatory community care.

The program will provide hospital and clinic-based experiences such that the dietitian/nutritionist will be able to manage the sophisticated needs of high-risk newborns in secondary and tertiary level newborn intensive care units, infants at high nutritional risk throughout the first years of life as well as high risk children and adolescents.

The four-month fellows will complete the first 16 weeks of the program. The six-month fellows also will complete weeks 16 through 23.

Rotation 1

Weeks 1-4: Normal and High-Risk Infants

• High-Risk Infant Units, Infant and Pediatric Intensive Care Units (Infants with failure to thrive, infants being prepared for discharge from NICU, infants with bronchopulmonary dysplasia, congenital heart disease, parenteral and enteral nutrition);
• Hospitalized infants/toddlers with cystic fibrosis;
• Pulmonary Follow-up Clinic that includes infants with cystic fibrosis; pediatric pulmonologist and nurse practitioner;
• Riley Child Development Center Clinic (Tuesday) includes interdisciplinary training in the care of the young child with neurodevelopmental and related disabilities;
• Supervision of background reading and in-depth discussion of normal infant nutrition and prevention of nutrition related disorders; coordination, supervision and/or provision of lectures for Advanced Pediatric Nutrition Course (N 540) (annual update of content); weekly discussion of didactic information and select topics of interest to the fellows such as an approach to developing a new nutrition program for a specific neonatal intensive care unit.

Rotation 2

Weeks 5-8: High-Risk Toddlers and Preschoolers with Special Health Needs

• High-risk Toddler and Preschool Age Units that includes toddlers with failure to thrive, feeding disorders, myelomeningocele, food allergies, and cerebral palsy, parenteral and enteral nutrition support for high-risk infants and toddlers; Riley Child Development Center Clinic (Tuesday) includes interdisciplinary training in the care of the young child with neurodevelopmental and related disabilities; interdisciplinary team;
• Inborn Errors of Metabolism Follow-up Clinic;
• Supervision of background reading and in-depth discussion of infants/children at high nutritional risk; chronically ill infants/children; coordination supervision and/or provision of Advanced Pediatric Nutrition Course (N 540);
• Weekly discussion of select topics of interest to fellows.

Rotation 3

Weeks 9-12: Adolescents Including Those with Diabetes Mellitus and Other Health Needs

• Teen Unit (adolescents aged 15-21 years), School Age Unit (adolescents aged 11-14 years) including those with Diabetes (type l) and other health care needs;
• Hospital Ambulatory Care Follow-up Clinics (Riley Transitional Clinics: Diabetes Mellitus, Cystic Fibrosis, Cardiology), Adolescent Clinics (eating disorders and weight gain), Inborn Errors of Metabolism Clinic, Community Ambulatory Services (Wishard Hospital, Action Center, Methodist;
• Riley Child Development Center Clinic (Tuesday) includes interdisciplinary training in the care of an adolescent with neurodevelopmental and related disabilities.

Rotation 4

Weeks 13-15: Healthy Premature Infant

• Intermediate Care Nursery (Level II newborn intensive care unit);
• Newborn Intensive Care Unit Discharge Planning Meeting that coordinates continuity of care in the community for infants following discharge;
• Newborn ICU Follow-up Clinic (Wednesday afternoon) that includes a system for screening, assessment and education/referral to community resources; prevention of feeding and growth related problems of VLBW infants; nutrition counseling and community coordination of care for high-risk infants with nutrition concerns or problems; nutrition in-services for community resources;
• Severe Bronchopulmonary Dysplasia Clinic (Comprehensive Care Coordination Twvi) that includes prevention of and intervention for feeding disorders: twice a month;
• Community Public Health (MCH) Clinics in Marion County, IN;
• Services for Children with Special Health Needs Clinic; MCH Programs in Indiana and integration of services into existing health care;
• Supervision of background reading and discussion of newborn requiring intensive care; coordination, supervision and/or provision of didactic content and case problems related to the newborn in intensive care, the third section of the Advanced Pediatric Nutrition Course (N540);
• Weekly discussion of select topics of interest to fellows.

Rotation 5

Weeks 16-23: Six-month fellows may choose from the following possible areas:

• At-Risk Infants in Intensive Care and Following Discharge Into the Community;
• Newborn ICU (Level 111);
• Newborn Intensive Care Unit Discharge Planning Meeting (continues);
• Newborn Follow-up Clinic (same as Rotation 4);
• Severe Bronchopulmonary Dysplasia Clinic (same as Rotation 4);
• Riley Child Development Center Clinic (Tuesday);
• Community Public Health (MCH) Clinics in Marion County, IN;
• Services for Children with Special Health Needs Clinic;
• MCH Programs in Indiana and integration of services into existing health care;
• Weekly discussion of select topics of interest to fellows.

Children with Special Health Needs

• Riley Child Development Center Clinic (Tuesday) includes interdisciplinary training in the care of the child/adolescent with neurodevelopmental and related disabilities;
• Inborn Errors of Metabolism Follow-up Clinic;
• Children with conditions such as cystic fibrosis, HIV/AIDS, cerebral palsy, myelomeningocele, congenital heart disease, failure to thrive, feeding disorders (enteral/parenteral nutrition);
• Community Public Health (MCH) Clinics in Marion County, Indianapolis, IN; Services for Children with Special Health Needs Clinic; MCH Programs in Indiana and integration of services into existing health care;
• Weekly discussion of select topics of interest to fellows.

Adolescents, Including Those with Diabetes Mellitus and Other Health Needs

• Teen Unit (adolescents aged 15-21 years), School Age Unit (adolescents aged 11-14 years) including those with Diabetes (type I) and other health care needs;
• Hospital Ambulatory Care Follow-up Clinics (Riley Transitional Clinics: Diabetes Mellitus, Cystic Fibrosis, Cardiology), Adolescent Clinics (eating disorders and weight gain), Inborn Errors of Metabolism Clinic. Child Development Center Clinic, Community Ambulatory Services (Wishard Hospital, Action Center, Methodist);
• Community Public Health (MCH) Clinics in Marion County, IN; Services for Children with Special Health Needs Clinic; MCH Programs in Indiana and integration of services into existing health care;
• Riley Child Development Center Clinic (Tuesday) (same as Rotation 3);
• Weekly discussion of select topics of interest to fellows.

Leadership Development Project

• Develop a proposal for real-world leadership development project that innovatively integrates some aspect of pediatric nutrition (services, education, advocacy, cultural competence or outcomes evaluation) into a health system;
• Apply the knowledge and skills related to leadership and pediatric nutrition, with mentoring and coaching from the key nutrition and leadership development faculty.
• Present the project at the end of the program.

One Week (Optional)

• Supervision for development of a proposal related to the integration of nutrition services into the Children with Special Health Needs care system or the integration of special needs children into existing health care system.