Update on Donating Breastmilk and Breast Pumps

I wanted to do a quick write up about donating breastmilk to the Indiana Milk Bank. I was able to drop off some of my extra milk to the Milk Bank and I was very excited and wanted to share about that experience. I was able to go through the approval process to become a donor. Then I went ahead and donated 687oz of frozen breastmilk. My mother had this milk in her deep freezer and she helped me drop it off at Columbus Regional Hospital. I was so excited to be able to give some of my milk to the Milk Bank to sell to hospital to use for preterm babies. 

If you are a breastfeeding mother and have extra breastmilk, you should consider becoming a breastmilk donor. Check out my first post about this - CLICK HERE. 

I also donated some breastmilk to a random stranger on Facebook .... gasp! I know right? I was torn about it. But here is why I did it ... I had some breastmilk that had been in a refrigerator/freezer for > 6months and I wasn't able to donate it to the Milk Bank. There standards can < 6months in a refrigerator/freezer. This was milk that I didn't need and I wanted it to go to someone that could use it. There was a lady on a Swap Group I belong to on Facebook who was needing donor breastmilk for her little one and she hadn't been able to find anyone with extra milk. I really felt like I could and should help her. I felt like I wanted her to get good, safe milk and I let her know that I was an approved donor through the Milk Bank. I was able to give her over 200 oz of breastmilk. Normally I am not a fan of just giving away your breastmilk to a stranger, but I felt like if you think about it and do what you feel comfortable with that can be the write call. 

I also wanted to touch on breast pumps. I have had several people ask me about my breast pump. I went ahead and purchased a Medela Symphony. This pump is a hospital grade pump and it is what you would use while in the hospital or if your baby was in the NICU. This is a great pump, but is very expensive to purchase on your own. Insurance won't purchase it for you. I was very torn about what type of pump to purchase. I really liked Medela, but there are so many different options and I kept hearing such mixed messages about all of them. I was really stressing about it and that is when my husband suggested we look online for a used Symphony. We found one on Ebay that was ~$600 and it has ~75 hours on the machine. This was a great deal when retail value is ~$1000. I knew that this pump would work well and I wouldn't stress about it. If I had rented the same pump through the hospital it is $60 a month and over the course of 12 months that costs $720. So I knew that I would get my money worth out of that pump if I purchased it on my own. I just wanted to share that story with you, because I don't think people realize that you can purchase a used Symphony pump. Now, please be smart about it when you shop on Ebay. But if you really want that hospital grade pump there are ways to obtain one for less than the retail price of $1000. 

If you are looking at getting a breastmilk pump through your insurance .... do your research, look online and talk to your friends. Try to figure out what pumps have good reviews and evaluate what would work for you. This is a big decision and you need to make sure that you are making the best choice for you and your little one. 

Peanuts and FDA Health Claim

Food allergies are on the rise amongst children. This is a common issue that lots of families struggle with. Peanut allergies are one of the most common food allergies out there. In fact, in the US the incidence of food allergies has increased 400% from 2007 until 2016. The incidence of peanut allergies has increased 450% in that 9 year span. This is an alarming increase in the percentages of food allergies and specifically peanut allergies. Researchers have been looking at ways to combat this alarming trend. For lots of children they tend to out grow their food allergies, but for some it is an issue they struggle with their entire life. 

There was a research study that was done in the UK in 600 infants looking at the exposure to peanut protein powder and their incidence of peanut allergies by 5 years of age. These infants were labeled as "high risk" because they has eczema and issues with eggs. The cohort was between the ages of 4-11 months when they were started in this study and they were followed through 5 years of age. This group of 600 infants were divided into two groups: 1) avoid peanut protein completely and 2) were given 6g peanut protein powder weekly. The research findings showed that there was a reduction in the incidence of peanut allergies by 81% in the group that was exposed to peanut protein. Out of that group only 1.9% ended up with a peanut allergy compared with 13.7% of the children in the complete avoidance group.  This is very interesting research because it definitely leads us towards the idea that early exposure could potentially help to decrease the incidence of peanut allergies. 

Currently the AAP says that you can give peanut/peanut products to children when you start solid foods if there is no family history of peanut allergies. If there is a family history of food allergies then have a discussion with your pediatrician first. With careful monitoring from a pediatrician and a dermatologist, you can still give your child some peanut protein and that small dose, over time could help reduce the incidence of an allergy in the future. There is a product on the market called Hello Peanut. This product is very interesting because it could help serve as a tool for health professional to exposure children to a small amount of peanut protein and with close monitoring could help prevent peanut allergies. The way the product works is you start with the introduction packets and use it for 7 days. Each day you give one packet of the peanut protein and each day the amount of peanut protein in the packet increases in volume. It is kind of like a peanut challenge. If your child is able to tolerate the increasing dose over that week then you can move up to the maintenance packets. One issue with the research study that I mentioned above, is that there is no set length of time that is associated with how long you need to continue this exposure to peanut protein to prevent an allergic response. They are doing a follow up study to look at having those 5 year old, not consume peanuts for a year and see if they are exposed to peanuts after that year, if they elicit an allergic response. 

This is all a neat idea to potentially decrease people's risk of developing a food allergy by giving them some exposure to this protein and letting their bodies adapt to that protein and not elicit an allergic response. 

There was a great write up in the New York Times about the Hello Peanut product and how it can be used. Again, this is best used under the supervision of a health professional to ensure the safety of the child taking this product. If you child already has a diagnosed peanut allergy this is not a fix for that condition. There is no cure of peanut allergies. 

The other really interesting thing about this research study is it prompted the FDA to look at this research and put forth a "Qualified health claim" that says that consuming foods with peanuts could potentially help prevent future allergies. This is the first time that the FDA has made a statement like this in regards to a food allergy. The whole claim is as follows "for most infants with severe eczema and/or egg allergy who are already eating solid foods, introducing foods containing ground peanuts between 4-10 months of age and continuing consumption may reduce the risk of developing peanut allergy by 5 years of age."  Now there needs to be further research in this area and the FDA does knowledge that, but this is a huge step forward for food allergy research and could have a big impact on those of children and their lives in the future.

If you missed the FOX59 segment talking about this research study that aired in Indianapolis, click this link! 

Donating Breastmilk

I wanted to write up a blog post on a topic that is near and dear to my heart .... breastmilk donation. As many of you probably know I work in a Neonatal Intensive Care Unit (NICU) here in Indianapolis. We purchase and use a lot of donor breastmilk for our premature babies. There are lots of studies that show that using donor breastmilk in a preterm infant can be a good alternative when there isn't enough maternal breastmilk available. We specifically use this donor breastmilk for infants who are less than 34 weeks gestation and less an 1500g (3lbs 5oz). 

Breastmilk is an amazing food. It contains protein, carbohydrates, fat, fat soluble vitamins and has immune boosting properties. This makes it the perfectly designed food for babies. Donor breastmilk can be a good substitute for small, infants who don't have enough of their own mother's milk to eat. There are two negatives of donor breastmilk, that I commonly see in the NICU. First, it is a pasteurized product and during that process you end up killing off some of those immune boosting properties and denaturing some proteins. Secondly, you are giving term breastmilk (the typical milk donor is has a term infant and is donating mature milk) to a preterm baby. It is not the perfect make up of fat, protein and carbohydrate for that gestational age. It has been found to be helpful in this preterm population. Mother's own milk is best, but if needed donor breastmilk comes in as a great second option.

So how does the process work? I have had parents in the NICU be grossed out by the thought of using someone else's breastmilk for their baby. There is a huge system in place to help ensure that breastmilk being donated is safe to use for your child.  

Step #1 - The donor speaks with someone at the Milk Bank and they are screened to see if they could potentially donate. There is a whole list of questions - CLICK HERE for Indiana's Screening Criteria.  The Milk Bank wants their donors to be in good health (you have to get signed off on by your OB and pediatrician), taking no medications, be willing to get your blood drawn and commit to donating 100 ounces of breastmilk. 

Step #2 - After speaking with someone at the Milk Bank you will fill out an application that will get turned back into the Milk Bank. You will also get your blood drawn. They want to make sure that you don't have any blood borne illnesses that could be transmitted in your breastmilk. 

Step #3 - Take your breastmilk to donate to your nearest Milk Depot. There is a list of Milk Depots available online. 

Step #4 - Once you donate your breastmilk, it is pooled together and then pasteurized. That milk is then combined in bottles that are frozen to be distributed to the buyers. The bottles are bottled with lot numbers and the have bar code that is attached to them. This would allow for tracking of milk if there ever was a problem.

There are a few things that you have to do to be a donor, but honestly that time that it takes is minimal and you are doing so much good for lots of babies out there. The NICU at St Vincent Women's and at Riley get their donor breastmilk from the Indiana Milk Bank. They are also the two largest purchasers in the state. There are lots of other NICU units that are purchasing that donor breastmilk as well. If you are interested in becoming a donor check out the Indiana Milk Bank website and give them a call. If you want to donate money to help support this non-profit check out their About Us section to learn more. 

Baby Led Weaning Part 2

I wanted to do another follow up post about Baby Led Weaning. Besides encouraging your child to use their hands and feed themselves, finding utensils/sippy cups that work for your child can be overwhelming. There are lots of products out there, but I wanted to take the time and highlight a few items for you. I have heard about these items from Katie Ferraro who is an amazing dietitian who has some great education on baby lead weaning.

What to use? This has been one of my biggest struggles since starting solids with William. Breast feeding is easy because you don't have to use anything special. But with starting solids it is a whole new ball game.

Products I Love!

Grabease

These are a great product that I discovered through Katie Ferraro. I ordered a set for William and I think they are great. William loves holding them and putting them in his mouth. I can't say he has mastered the art of using utensils, but he has a ton of fun playing with them. These utensils are ergonomically designed to fit little ones hands. It allows for a natural vertical grasp and has a choke protection barrier to allow for safe self feeding. These also work great for baby led weaning. They can easily be cleaned in the dishwasher and are BPA free.

Ezpz Mat

I have to confess I have used this only a few times, but I love the concept for this utensil. This all in one placement and plate works well to contain food. It also sticks to the table and it is hard to pick up and toss to the floor. The compartments can hold two 4oz portions and then one 10oz portion. That would work for a fruit/veggie, protein and carbohydrate. This is easy for a small child to use and work on developing their fine motor skills. You can wash it in the dishwasher, use in the microwave and it is oven safe up to 350 degrees. 

Take and Toss Sippy Cup

I had two packages of these given to me from a friend and William loves them. I love this because it is durable to use again and again, but if it is lost it is not the end of the world. The colors are fun and they travel cap works great. They also don't have a valve, which I really liked. I want William to be able to gain the skills to control the flow of the milk out of the sippy cup and this will allow him to practice that skill. These are dishwasher safe as well and BPA free. 

What products have you used that you like? Are there any  brands or types of baby feedings products you really liked? There are so many types of feeding utensils out there it can be overwhelming. If you are on the hunt for some great products to try, make sure you check these out! 

If you missed my first blog post about Baby Led Weaning - CLICK HERE to learn more about how this is a great way to teach your child to love food! 

National Breast Feeding Month

In case you didn't know, August is National Breast Feeding Month. Many of you probably already know that I am breast feeding my first child. We have been going strong for the last 7 1/2 months. It is a big commitment. I haven't really talked about breast feeding here on the blog since William was first born. That first post was entitled The Gift of Breast Feeding. I think that is such a good way to look at breast feeding. It is A LOT of hard work and it is truly a gift that you are giving to your child. I made that choice for William and I try not to complaining about breast feeding/pumping, but instead look at it as a wonderful opportunity that I GET to do and I am giving to him. 

I have been volunteering with the Breast Feeding Support Group at St Vincent Women's Hospital for the last several weeks. I am working towards getting experience and hours for my IBCLC certification. This credential stands for an International Board Certified Lactation Consultant. This credential is a great way to get continued education about maternal and infant health/development and how to help mothers trouble shoot breast feeding. I have really enjoyed being able to work with some Moms on Fridays in an outpatient setting. It is so neat to see these mothers band together, lift one another up and support each other in this journey of motherhood and breast feeding. I was talking with one mom who said that the support of the lactation consultants and this group has helped her so much that without that support she wasn't sure she would still be breast feeding. That is a huge testament to supporting and educating mothers on how to trust their bodies to provide milk for their babies. I think lots of times we have the false idea that we, as the mothers, are in control of the feedings for the baby. In all actuality, the baby determines how much they want to eat and how they are going to do it. Trusting your baby and body is a tough thing to learn. Getting to work with some of these moms and encourage them has definitely been the highlight of my Fridays. 

Breast Feeding Facts 

• Breast feeding helps you save money $$$ 
  • Feeding your baby formula can cost you ~$1,500 a year or an average of $30 a week. 
  • Because breast fed babies are less sick, you will miss fewer days at work to stay home and take care of your baby.
• Breast feedings helps keep your baby healthy.
  • Your child is less likely to get sick when they are breast fed. Your breast milk can help prevent ear infections, diarrhea, respiratory illnesses, childhood obesity and childhood leukemia. 
  • Breast milk and breast feeding your baby helps to decrease the risk of SIDS by > 70%. 
  • Breast feeding if good for your health (as the mother), because your risk of breast cancer and ovarian cancer also decreases. 
• Commit from the beginning. 
  • Mothers who have a plan from the time before their child is born are more likely to stick with it. Breast feeding is tough and can be challenging, but those mothers who are determined are more likely to stick with it. 
  • Getting your support system on board with your plans to breast feed will help you be successful as well. 
• Breast milk nature's perfect food. 
  • Your breast milk is designed for your baby. It is easier for your baby to digest than formula and you pass along your immune fighting agents to your child. You are the mother, have the power to give this unique and perfectly designed food to your baby. 

Baby Led Weaning

It has been a little while since I have share with you about my little one, William. You got to hear all about my pregnancy and how things were going. I wanted to move onto another fun topic that I enjoy ... pediatric nutrition. This is totally my jam. Now my main focus is neonatal nutrition and obviously my child is out of that stage. He is now 6 months old! He is moving and grooving. He started crawling just around 6 months old. He is now obsessed with pulling up on things. When he pulls up and stands on his feet he is SO proud! He is just jumping through ALL of these milestone hoops. Over the last couple of weeks we have also started solid foods.

I am doing Baby Led Weaning with William. I am not sure if you have heard of this approach, but I think it is one of the best ways to teach your child how to love food. The premise is that you use table foods (foods that you would normally eat) and use those to teach your child how to eat. There is no jar baby food involved. Those products are over priced and totally void of much nutritional value. If you want to feed your child is a healthier and most cost effective way ... then keep reading, because this method is for you.

Baby led weaning simply means letting your baby feed themselves from the start of solid foods. There is no force feeding baby food mush. The term was coined by Gill Rapley who was a midwife. Check out her book HERE. Around 6 months or when your baby is able to sit up and is showing interest in foods if when you can start offering table foods. You simply hand your child a suitable size piece of food and they can play with it, smell it, lick it, mash it up, get it all over them and get the full experience of eating. At the beginning a very small portion of the food actually gets to their mouth/into their bellies, but they are learning all about food during this time. There are no purees, no ice cube trays, no food processing, no mashing of foods, no baby cereal or strange jar food combinations. Instead it is your baby eating food that that you eat at your dinner table.  

Baby Led Weaning

• Encourages and teaches family meal time. Everyone comes together at the table and eats together. The baby gets to participate in meal time by being at the time and eating appropriate finger foods that the rest of the family is eating.

• The child gets to choose what, how much and how quickly they want to eat.

• This method gives the chance to explore various new textures and tastes. There is no pressure to have to eat something.

• Continue to nurse or give a bottle just as often as you normally would. Solid foods at this point are made to go with the milk. The baby will regulate and start to eat more solids and decrease milk intake on their one. Usually this will occur later in the first year. For a baby at 6 months old, the main source of their nutrition is either breast milk or formula.

When you think about it baby led weaning ends up being a continuation of breast feeding. When a baby goes to breast, that baby is determining how food milk he is drinking. When he is satisfied he is done. The breast milk will take on different flavors, depending on the mother diet and this is an early introduction of what food tastes like and will increase baby's acceptance of those foods later in life. These concepts are continued with baby led weaning, because the baby is deciding if they want to try foods and how much of foods they want to try to eat. This method encourages that self regulation and exposures to various foods.

If you have questions about baby led weaning or want more information, send me a message. I have various resources that I would love to share with you. I believe that is it so important to build a healthy relationship with food and that starts when your baby first starts solid foods. 

Diabetes Youth Foundation of Indiana Camp 2017

This is my third year attending Diabetes Camp with the Diabetes Youth Foundation of Indiana. The camp is located up in Noblesville, IN and each year for a week I spend my time preparing foods for campers with food allergies. Lots of Type 1 diabetic patients also have food allergies or other autoimmune related diseases (such as Celiac disease). For their week at camp I work to help prepare "safe" foods for them to eat. My week at camp was crazy busy. We had 10 campers that had celiac and had to be gluten free. Then we had several vegetarians and one dairy free camper. With each meal I had to make sure that they had substitutes for the food items that were being served. I had to heat up and prepare 11 gluten free mac n' cheese diseases one meal and then make a pasta with red sauce dish for my dairy free camper. That basically summed up my week. It was great though, because I get to do something different for a week and I love being able to give of my time in that way. 

What I love about DYFI Camp? I think it is so great that these campers (all of which are Type 1 diabetic) can come to a place for the summer and get to feel "normal." Everyone else there as diabetes and checking your blood sugar/giving insulin is the norm. I also love that we support them with food that they can eat as well. We make sure that their food allergies are accommodated for and they are able to eat family style at meals. That is wonderful because they can choose what they want to eat and then their insulin bolus is given accordingly. Having a place where these campers can be just kids having fun is something that is so special.

Another exciting moment for this year was that we were able to donate the extra food to a food pantry/shelter in Noblesville. I was so excited to take the extra dry goods and fresh foods over to Third Phase Christian Center. These food items wouldn't have kept in the freezer until fall camp and so if we didn't take them somewhere they would have to be thrown out. I was so happy that they were able to be given to a group that could use the leftovers. They were very excited to receive the fresh food as a donation. They even were able to take opened food items that they used in their kitchen on site and whatever was unopened they could give away in the food pantry. 

It was a great week at camp. Everyone had a wonderful time. The weather was great. The kids got fed and I would call it a success! 

IAND Spring Meeting

I had the opportunity this last week to attend the Indiana Academy of Nutrition and Dietetics (IAND) Spring Meeting. Not only did I get the chance to attend for one of the two days, I also got be a presenter. I was asked to talk about being a Neonatal dietitian and what my role is in the Neonatal Intensive Care Unit (NICU). I was honored be to asked to speak and was excited to share about my job. I think I have a really neat job and having the chance to talk about nutrition in newborn, preterm babies is like a dream come true. #nerdalert 

The day of conference speakers was fantastic. I really appreciate having the chance to network with my fellow RDs around the state and also have the chance to learn more about nutrition. I thought I would share some of the highlights from my presentation and some of the highlights from the conference as well. 

Below you will find some of my favorite slides from my presentation. I talked about the history of the NICU and how nutrition plays an important role in the development of these preterm babies. I discussed the various types of formula available and how our goal is to use maternal breastmilk for feedings. I also talked about assessing growth in newborns and how we run our Formula Rooms to prepare feedings for our patients. 

The entire day at the IAND Spring Meeting as fantastic there were several speakers who discussed some very interesting topics. 

• Sharon Palmer, RDN spoke about eating a Plant Based Diet and finding ways to incorporate more fruits and vegetables in your daily meal routine. She did a great job and at highlighting the importance of eating more plant based and how it can taste good. I liked how she didn't put down meat in a negative way, but instead encouraged using meat as a seasoning and less of the main course. 
• Kate Byers, MS, RDN spoke about everything coconut. Kate is a fellow Purdue Alum and we have gotten to know one another on the College of Health and Human Sciences Alumni Board. She had a great presentation talking about coconut - how it is grown, how it can be used, what to look for on labels and some research about how healthy it really is or is not. 
• Sandi Morris, RDN also spoke about Order Writing Privileges for RDs in the state of Indiana. That was a great topic to discuss, because that can change how RDs operate in the hospital setting. 

It was a great day and I was so excited for the chance to attend and have the opportunity to speak! 

The Powers of Breastmilk

I had the opportunity for the past week to attend an amazing 5 day long conference about breast feeding. I know for some people that might not be an exciting topic, but I thought it was fascinating. St Vincent hosted the event and brought in two wonderful speakers to teach us for the 5 day course. The name of the course was Foundations for Best Practice for Lactation Care and the instructors were from Evergreen Hospital in Seattle, WA. Molly Pessl was one of the instructors and she has been a nurse for over 50 years. She has been working with lactating mothers for the majority of that time and is such a wealth of knowledge on the topic. 

I hope that over the next year or so I can work towards completing the course work to become a IBCLC or an International Board Certified Lactation Consultant. I first was exposure to working with women and breast feeding at WIC during my dietetic internship. I really enjoyed that part of the rotation, but didn't think much more about it, until now. I work in a NICU and we are always wanting and needing maternal breastmilk for our little babies. I thought that this would be a great time to start working towards that credential. Then this 5 day course was offered by St Vincent and I had to do it. 

I just thought I would share with you some of the amazing things that I learn during this coursework. I have never attended a lactation conference before so everything that was shared was new to me. We talked about the changes/development that happens for Mom and the baby during pregnancy, delivery and into the 4th trimester. It is amazing how the woman's body is designed to sustain life in the womb and afterwards. We talked about how the mammary glands work and how the hormone changes creates breastmilk for the infant. We talked about child development from in utero through 12 months of life. It was neat to discuss case studies as a group and have this chance to learn from the experience of people in the class. Of course at the end of the 5 days, I was so excited about everything that I have learned. I obviously think breast feeding is an amazing thing and something that every woman should be encouraged to do. It is worth all the hard work and effort to provide this unique food to your baby for a few days to a few years. 

I hope this post helps to normalize breastfeeding. This has been the way babies have been fed for thousands of years. I know that baby formula can help and save lives for lots of children, especially those who are premature, but their own mother's breastmilk helps even those tiny babies. I hope you are encouraged by this post and have a desire to show support and love to those mothers who are out there breastfeeding their babies and giving that gift to their children.

Vitamin D and Your Child

When you have a newborn baby you have probably heard your pediatrician talk about Vitamin D. They have probably asked you if you are giving a Vitamin D supplement to your child. Now you might be wondering why this is necessary and how important is it really? Well that is what I wanted to share with you is the importance of Vitamin D for your growing baby.  

Vitamin D is a an essential vitamin that your need to get through sunlight exposure and your diet. The challenge for all of us, especially in the winter, is getting enough sunlight exposure. This holds true for adults and children. If you are breastfeeding your infant, your breastmilk doesn't pass along very much Vitamin D. If that is solely what your infant is getting for nutrition and it is the middle of winter, your child really needs a Vitamin D supplement.  There was an article that was released this past week that prompted me wanting to write this post - CLICK HERE for a link to that write up. 

Why is Vitamin D important? Vitamin D helps with bone development and if your child isn't getting enough in their diet, sun exposure or via a supplement they can develop rickets. This occurs when the bones are weak, they bend and children have issues walking. This can be prevented through simply making sure your child is getting a minimum of 400 IU (international units) of Vitamin D each day. If your child is taking breastmilk or formula, supplementing with Vitamin D is necessary. There is an estimated 1 IU of Vitamin D in 1 fluid ounce of breastmilk. This is surprising for a lot of parents, but most people hear that breastmilk is the perfect food for your infant. That is true for most nutrients and for all of the antibodies that are passed via breastmilk. The one area where breastmilk falls short for term infants is the amount of Vitamin D available. Fortified baby formula contains 15 IU of Vitamin D in 1 fluid ounce of formula. Again, this surprises a lot of parents, but formula is designed to be nutritionally completely, but it like breastmilk is inadequate in the amount of Vitamin D it provides. As you can see, when the recommendation daily for infant is 400 IU per day, both breastmilk and formula fall short of meeting this goal. That is why providing your infant with a supplement is needed. 

Supplements - Now that we have established that your child, whether breastfeed or formula fed needs additional Vitamin D what are you going to purchase? There are lots of different brands of Vitamin D that are available. The main thing you want to make sure is that when you purchase a supplement you are giving 400 IU per day to meet the recommendations set out by the American Academy of Pediatrics. Most supplements will provide 400 IU in about 1mL of a liquid supplement that you would squirt in your infant's mouth daily. There is a product out there that provides the 400 IU of Vitamin D in 1 drop of this liquid, which can be placed on the mother's breast. This would mean the child would ingest it when they go to breast. This product is called Baby Ddrops. There are a variety of products out there and finding what works for you and your child is important. 

The main take away from this post is to help encourage you to give your infant their daily dose (400 IU) of Vitamin D each day. It is necessary for proper bone growth and development. When possible, make sure you take your child outside and get some sun exposure as well. Being outside for 15 minutes at midday with full sunshine would provide an adult with 10,000 IU of Vitamin D. So being outside for a less than 15 minutes as a child will help to meet their daily Vitamin D goals.  

The Gift of Breastfeeding

So I am officially a breastfeeding mama. It has been quite the adventure let me tell you. I have worked with Moms and breastfeeding with my job a Registered Dietitian and on a feeding team, but this is my first time actually doing this myself. I wanted to make sure that I talk about on this blog the reality of breastfeeding. Sometimes I think Moms aren't exactly sure what they are in for and sometimes it can be very overwhelming. 

Here are some statistics for you about breastfeeding that came from an article that was released just a few days ago: 

• In 2012, estimated 80% of mothers started breastfeeding their infants. By 6 months of age, an estimated 51.4% continued to breastfeed and by 12 months of age that number fell to 29.2% of mothers still breastfeeding. 
• Goals for Healthy People 2020 are for these rates at birth to be at 81.9%, by 6 months keeping 66.6% of mother breastfeeding and by 12 months of age having 34.1% of mothers continuing to breastfeed.
• Breastfeeding support programs are effective in helping to encourage and support mothers of all ages to continue to breastfeed.
• Breastfeeding has several maternal benefits including - lower risk of breast and ovarian cancers, less visceral adiposity, reduced rates of diabetes and cardiovascular disease in the mothers.

I wanted to make sure that I shared with you some of my experiences with breastfeeding. I have only been doing this a few weeks, but I think it is an important thing to talk about and prompt discussion.

The initial latch - Can we talk about how when your baby latches for the first time it hurts? It is very uncomfortable. I was really concerned at the beginning that William wasn't latching correctly and that was causing some pain, but after speaking with a lactation consultant in the hospital, he was doing a great job and had a great suck. It took about 2-3 days for the initial "pain" with the sucking to go away. Lanonlin was my best friend. That helped so much to help relieve some of that pain and keep my nipples from cracking and bleeding. I would apply it after each time breast feeding. 

Milk coming in - Oh my goodness this was a surprise. My milk came in on day #3 after having William and WOW! I was so overwhelmed. It was painful to have super huge boobs and have them filled with milk. I didn't know this was going to happen so quickly. I had a ton of milk immediately and I didn't know what to do with it all. Originally, I was not going to pump for the first month, but when my milk came in I had to pump. I had to relieve that pressure. So I started pumping twice a day and I have been sticking with that regime since that first day home. 

Engorgement - I didn't know how to handle this side effect of breastfeeding either. I wasn't prepared for the engorgement feeling and again because my milk came in so quick I was so overwhelmed. It was such a crazy experience to be solely responsible for feeding your child. I have been thankful that I have a good milk supply. I know that lots of women struggle to increase their supply. Breastfeeding is tough and takes lots of time. 

It is a gift - In the midst of feeling overwhelmed and learning how to breastfeed I had a wonderful chat with my husband, Chas. He was so encouraging and helped to remind me that I didn't have to breastfeed. If there was any point that I felt like I didn't want to breastfeed, I didn't have to. There are other ways that we could feed William. He reminded me that he would support me in whatever I decided to do. He also said that if I continue to breastfeed that is a special gift that I am able to give William. It is something that I can choose to give him. Taking that perspective has been so helpful for me. Viewing breastfeeding and pumping as a gift for my son really hit home for me. I thought this perspective was worth sharing. If you are a breastfeeding Mom and feeling discouraged, remember what you are doing 6-12 times per day is a gift. All of the hard work is something special that you can give your child. 

I will keep you posted on how breastfeeding is going. We are now 3 weeks into this adventure and it is going well. William loves to eat and is growing quickly. Our next big challenge will be next month when William goes to daycare and I head back to work. Until then, we will continue to breastfeed, practice with a bottle 1-2 times a day and pumping ~3 times a day. Keep up the hard work if you are currently breastfeeding and if you know someone who is breastfeeding give them a pat on the back. 

Working In A Formula Room

It has been awhile since I have spoken about my day job here on the blog. As you may recall, I work in a Neonatal Intensive Care Unit (NICU) and I am a pediatric dietitian. I work with newborn babies and I calculate their nutrition needs to help them grow appropriately since most of our patients are born early. Another part of the job, is helping to oversee our Formula Rooms. This is the part of the NICU where all of the feedings are put together/made for our patients in 24 hour batches. We help to schedule, oversee and hire the Formula Room Technicians that work in those mixing rooms. Sometimes the dietitians fill in those shifts as well if we don't have enough techs to fill the spots on a particular weekend. 

This last week I have had the opportunity to work in our Formula Rooms a couple of times. I am always impressed with our system and how we so accurately get all of our babies fed ~ 8 times a day. It is truly a well oiled machine and is so neat to be a part of that. 

I thought it might be neat to address some of the Frequently Asked Questions that I get about our Formula Room/NICU and how nutrition plays a role in that environment. Most people are surprised to learn that there are dietitians in the NICU and that we have a mixing room for feedings. 

Frequently Asked Questions

1. What does a dietitian do in a NICU?
   • This is a great question. The role of a dietitian in a NICU varies, but the main role is to help provide nutrition care to this specialty population. The RD serves as the nutrition expert on the medical team and provides guidance/advice to the neonatologist about  the best feeding recipe for each patient. Each week the RD sees every patient in the NICU and writes up a nutrition note about their plan of care that week. The RD would suggestion what feeding option might be best for that patient, the avenue of administering the feeding, when start vitamins, how feedings might change based on lab values and monitor growth velocity and tweak the nutrition plan as needed. 
2. Do you just mix formula in the Formula Room?
   • No. In our Formula Room we prepare ALL of the feedings for ALL of our patients and they are stored in a refrigerator in that room. The RN will come in and out of the Formula Room to get the feedings and take that aliquot to the bedside and feed the baby. Each patient has their own bin in the refrigerator and their feeding is in that bin for the RN to grab anywhere from 6-8 times per day.
3. How do you feed your patients?
   • In the NICU, since our patients are normally premature, our most common form of administering nutrition is via a feeding tube or via TPN. We prefer to use the GI tract and will try to give feedings via the feeding tube and we work to wean TPN support as soon as possible due to line infection risk and liver damage. Infants do not have their swallow/feeding reflex developed until ~34 weeks gestation and so that would be the point that with cues, we might start some bottle feedings. 
4. Do you feed your patients breast milk? 
   • Yes. Our goal is to use maternal breastmilk whenever possible. That is the gold standard for all of our babies, because it has so many protective properties. Some times there are medical diagnoses that prevent the use of breastmilk, but those cases are limited. Premature babies also need higher calories, more fat and more protein. They are born early and their nutrition needs are higher compared with a term infant. This means that unfortified breastmilk won't meet their nutrition needs so in the NICU we use different formula/fortifier to add to the breastmilk to increase the calories, protein, fat and other vitamins the infant is receiving. We have recipes that we use to mix these feedings and that is the primary role of our formula room technicians. They are the ones that will mix up these recipes for each baby in 24 hours batches and those feedings will be used throughout the day by the nursing staff.
5. How much do you prepare each day in the Formula Room?
   • Our technicians make 24 hour batches for all the babies that we are mixing for that day. Our NICU holds 90 babies and our nursery unit holds an additional 10 babies. There is the potential that we could mix for all 100 babies, but that is normally not the case. It is inevitable that there is a baby or two who are NPO (nothing by mouth). Our average census is ~70-80 patients at a time. 
6. Why do you have technicians mixing feedings compared with nursing staff? 
   • Nursing staff in some hospitals do mix feedings and they have at our hospital in the past. With this creation of a Formula Room space it is more conducive to having one person mixing up feedings compared with each RN mixing their feedings. It decreases the number of people in the room and would decrease risk of errors/infection risk. We work hard to make sure that our technicians are trained well and mix the feedings appropriately. This helps give the RNs more time at the bedside to do what they do best, provide that direct care for our babies. 

Hopefully this has given you a little better idea about what we do in the NICU and how we provide top-notch nutrition care to our patients. We have some of the sickest babies in the state at our hospital and I am so proud of our medical staff for the level of care that we provide each and every day! 

Scary Halloween Facts

Today is Halloween! October 31st! That means if you haven't already, you will have little ghosts, goblins and princesses showing up to your door and asking for treats and goodies. I hope you were able to read the post from last week about the Teal Pumpkin Project and possibly put together some allergy-free treats for your trick-or-treaters. 

I also wanted to share with you some scary Halloween nutrition facts, because it is fun and ends up being eye opening. These statistics are brought to you by Daily Burn. 

• Americans spend ~$7.4 billion dollars on Halloween candy, costumes and decorations each year. 
• Americans purchase 90 million pounds of chocolate during the week of Halloween. 
• There are 41 million potential trick-or-treaters between the ages of 5-14 years old in America.
• Each year, 35 million pounds of candy corn is produced for the Halloween/Fall season. 
• If you ate an apple cider donut, you would have to do 54 push-ups to burn it off (~330kcal). 
• Do you love the Starbucks Pumpkin Spice Latte? If you drink a tall (~380kcal) you need walk for 134 minutes to burn off those calories. 
• Did you know there are 10.5g of sugar in a Reese's Peanut Butter Cup and this happens to be American's favorite Halloween candy.
• You would have to do 17 minutes of burpees to burn of 1 bite-sized Snickers bar (~160kcal).
• Wondering how much your pillowcase can hold in terms of candy - 1,690 pieces of candy to be exact. 
• On Halloween, children collect any where from 3,500-7,000kcal worth of Halloween candy in their pumpkin pails. 

I don't want you to know that I don't love Halloween, the treats, goodies and decorations. I love celebrating holidays, but I think it is important to remember that you or your child do not need ALL the Halloween candy. Trying to keep moderation at the fore front of your mind is the main message. Enjoy your time trick-or-treating, taking pictures and dressing up. Just try to be active, burn off those extra calories and make sure you have a healthy dinner before you head out. Have a safe and wonderful Halloween! 

Navigating Food Allergies on Halloween

This is a topic that is near and dear to my heart. Every year I try to take some time and make sure I talk about the Teal Pumpkin Project. This program is sponsored by the Food Allergy Research & Education group and its main focus is to provide all kids safe treats this Halloween. This campaign was launched back in 2014 nationally and has gained lots of traction over the last 2 years. 

For kids with food allergies, it is not safe for them to eat candy, because often these sweet treats contain dangerous allergens. This project wants to encourage people to provide non-food treats for trick-or-treaters so that they can still participate in the Halloween traditions, but not have to worry about their food allergies. To participate in the Teal Pumpkin Project follow these simple steps: 

1. Have non-food treats available for kids to pick up. It is easy to find Halloween themed goodies at your local grocery store, party store or craft store. Plus, these are great goodies to hand out to all the children, because they are going to get plenty of sugary treats.
   • Bubbles 
   • Pens/pencils 
   • Glow sticks/necklaces/bracelets 
   • Vampire fangs 
   • Stickers 
   • Bouncy balls 
   • If you don't have time to run to the store to find these goodies - go ahead and purchase the Essentials Kit from FARE Teal Pumpkin Project and get it shipped directly to you! 
2. Put out a teal pumpkin in front of your home, on your porch/in your entry way. Incorporate your family and paint your teal pumpkin today! 
3. Display the FARE Teal Pumpkin Project sign  explaining what the teal pumpkin means.

Not All Formula Is Created Equal

I decided to put together this blog post because I work in a NICU (Neonatal Intensive Care Unit) and we work with a lot of breastmilk and baby formula to feed our patients. This is my area of expertise and I had the pleasure of recently attending lunch with a formula rep and talking about formula. This luncheon, brought this topic to the fore front of my mind - Not all formula is created equal. I don't want this post favor one brand over another. I just want to bring some facts to light that you might find helpful. My perspective is that for all babies, breastmilk is best and is a very unique substance. We have worked for years and years to try to create a formula that mimics breastmilk. For some of our babies in the NICU, we have to add things to the breastmilk to increase nutrients because our patients are born early and breastmilk isn't designed to meet their unique nutrition needs. 

That being said ... I wanted to discuss all the different types of formula and how there are various brands. In the US, we have Similac, Enfamil, Gerber and Store brand options. All of these companies abide by rulings set out by Congress in the 1980s, referred to as The Formula Act. This piece of legislation has been around for awhile and unfortunately hasn't been totally updated since then. There have been guidances given for the formula industry and an example in includes the health claims made by formula companies (September 2016).  Baby formula always ends up being a controversial topic. Thankfully all of these companies continue to create and work on new research in the area of baby formula even though the standards they have (required by law to follow) are now ~35 years old.  There are lots of different types of formula options within each brand and some times the options can be overwhelming for parents. The main focus that I wanted to bring to your attention is that the brand name formulas may cost more, but there is more research being done in those products and they are up to date with the best nutrition compared with the generic products. Just so you are aware, the generic version of the formulas are the older recipes from the brand name companies. This means they may not contain some of the important nutrients that we have discovered and are now able to add to formula. This means that as the consumer you are getting a product that is based on older research and may not be as helpful for their baby's growth and development. This is the one time in your baby's life when they are eating 1 food item to get all the nutrients that they need to grow and develop. Whether it is breastmilk or formula this is a very unique time for your child (the 1st 12 months of their life). 

For example, we have learned that DHA (docosahexaenoic acid or omega-3 fatty acids) and ARA (arachidonic aicd or omega-6 fatty acid) are very important for brain development in infants. These fatty acids have been around awhile and most of the generic formulas that I looked at had at least DHA in them. Another important phytonutrient that is now being added to formula is Lutein. It helps with eye health and is a carotenoid that has an important role to play in brain function/development. We didn't necessarily have this information back when the Formula Act was put together so if you read the label for a generic baby formula and make sure that these formulas have these nutrients added. Most of the ones that I glanced at, did have these nutrients added, which was reassuring. These nutrients are naturally found in breastmilk and has we do more research they are being added to infant formulas as well. 

I wanted to also just touch on the different types of baby formula so that you know what you are looking at when you go to the baby aisle of the grocery store. There are lots of options and often the challenging is just determine, which product is appropriate for your baby.

Different Types of Baby Formula - 

• Cow milk protein-based formulas. Most infant formula is made with cow's milk that's been altered to resemble breast milk. This gives the formula the right balance of nutrients — and makes the formula easier to digest. Most babies do well on cow's milk formula. Some babies, however — such as those allergic to the proteins in cow's milk — need other types of infant formula.
• Soy-based formulas. Soy-based formulas can be useful if you want to exclude animal proteins from your child's diet. Soy-based infant formulas might also be an option for babies who are intolerant or allergic to cow's milk formula or to lactose, a carbohydrate naturally found in cow's milk. However, babies who are allergic to cow's milk might also be allergic to soy milk.
• Protein hydrolysate formulas. These types of formulas contain protein that's been broken down (hydrolyzed) — partially or extensively — into smaller sizes than are those in cow's milk and soy-based formulas. Protein hydrolysate formulas are meant for babies who don't tolerate cow's milk or soy-based formulas. Extensively hydrolyzed formulas are an option for babies who have a protein allergy.

*In addition, specialized formulas are available for premature infants and babies who have specific medical conditions.

My intent with this blog post is not to make you hate formula or purchase only a certain type of formula. I just wanted to make sure that you knew how much research goes into infant formula and how it is always being updated and our knowledge base is growing. Breastmilk is an amazing substance that women's body can produce and we have spent lots of time and money trying to find ways to create a formula that mimics what nature can create. I am a huge proponent of additional research and I am always excited to hear what companies have learned and are able to add to their formula products. 

If you end up with questions about formula, please don't hesitate to get in touch with me and I would be happy to talk with you more about this fascinating topic of infant nutrition! 

Kids Eat Right

I know that I kind of missed the mark with this post. It is a little late, because August was Kids Eat Right Month and I know it is now the beginning of September, but I am think this is such a great topic that we should continue to talk about it into September. 

As many of you know, I am a pediatric dietitian and I feel passionately about good nutrition for our kids. This week I am was asked to put together a display booth as a Elementary/Jr High Wellness Night at a private school. I also have the chance to be on Indy Style again talking about school lunches (tune in tomorrow at 9am on WISH TV). I thought this would be a great topic for the blog this week and really focus in on recommendations for school-aged children.

There was also a great news article that was released at the end of August from the American Heart Association talking about children and sugar consumption. This statement came from research put out in the publication Circulation, looking at how sugar affect children's overall health. The recommendations are that children/teens (ages 2-18 years old) should not be consuming more than 6 teaspoons of added sugar per day. Added sugars are classified as table sugar, fructose, honey found in processed/prepared foods or beverages, sugar that is added to foods at the table or eaten separately. It has been determined that children eating more than this per day (> 6 tsp added sugar) are often consuming more unhealthy food items. 

Now you have to be wondering what in the world can you do to cut back on your child's sweet treats? Well thankful there is a great handout from the USDA on this exact topic. 

In addition to just sugar intake, overall diet is important as well for children to grow/develop to their full potential. As a parent/caregiver, the responsibility falls to you to help make sure that your child is getting the proper nutrition that they need. You should be aiming for a well-rounded, balanced plate at every meal. I know that feel intimidating, specially if you have a picky child. But keep offering healthy options and encourage your child to take at least 2 bites of each food item offered at that meal. 

Your child's plate will be smaller compared with yours, but it should still contain all of the above mentioned food groups (Fruits, Vegetables, Protein, Grains and Dairy) with each meal. Now I know it can be challenging to fit in vegetables with your breakfast, so if that doesn't happen every morning, make sure to offer another vegetable at lunch/dinner and move a fruit to a snack in the afternoon. 

Tips for a Healthy School Lunch

1.  Incorporate fruits and vegetables in a fun way. Variety your produce options in the lunch bag. Use different dips throughout the week with the veggies (hummus, ranch, sunbutter) or with the fruit (like yogurt). Cut up the fruit/vegetables so that your child is more likely to eat them. 
2. Make the bread on their sandwich whole grain. This could be sliced bread, crackers, pita or a wrap. You can have a variety of types of sandwiches (lunch meat, PB&J, chicken salad). 
3. Have a snack for them in their bag for later in day – for the ride home on the bus or in between school and a sports practice. Make this something easy to carry that doesn’t need an ice pack – granola bar, crackers, dried fruit, or nuts.

If you  have more questions or want more information about planning healthy, meals for your family, feel free to get in touch with me! Have a great Monday and hope your Labor Day weekend has been amazing! 

Another Week at Diabetes Camp

The last week of June I had the pleasure of getting to help out a Diabetes Camp in Noblesville, IN. The Diabetes Youth Foundation of Indiana puts on a week long camp for three weeks every June for kids with diabetes. Commonly this kiddos are type 1 diabetics, but it is a great opportunity to have these kids enjoy a week at camp and have the diabetes taken care of during that time. 

This was my 2nd year back at this camp and it went great. We had a wonderful week! My role is that of a "lunch lady." I am in charge of making the food substitutions for the kids with food allergies or special dietary needs. Last year I had a ton of these kids (like 12-14), but this year it is a much smaller group. I have 2 girls with celiac disease, 1 boy with dairy, peas, peanut allergy, 1 vegetarian camper and another boy with just peanut allergies. My role was to prepare the food substitutions for meals. For example ... on a night with chicken strips, I would get and prepare gluten free chicken strips for the celiac campers. I wouldn't have to prepare their whole meal, just a portion of it. It works well because the head dietitian for the camp, does a great job putting together the menu each year, which includes fruit, vegetables, lean protein and dairy. It is a well rounded meal plan. There is always 1 dietitian each week to help oversee the kitchen area and the campers with food allergies/restrictions. This year we had another addition - a Purdue intern. Her name is Molly and she helped us in the kitchen throughout the week. She just finished her sophomore year at Purdue and is majoring in Dietetics and Nutrition, Fitness & Health. She was a great addition to the kitchen crew and did a great job. 

It was a busy week. When I wasn't working in the kitchen getting meals ready, I was using my time to chart on our NICU babies. Our census has been crazy high this summer in the NICU so we have been busy. It was a great experience as always and I really love being able to volunteer and spend some time each summer out at this Diabetes Camp. If you know of anyone with Type 1 Diabetes then make sure you share the Diabetes Youth Foundation of Indiana website with them and maybe next year they can go to camp! 

Childhood and Adolescent Weight Management Certificate Program

I had the opportunity to attend the Childhood and Adolescent Weight Management Certificate Program in Indianapolis last week. It had been a goal of mine for the last couple of years to attend that program when it was closer to where I live. They offer the 3 day program twice a year and they rotate the sights all over the country. This spring it was in Indianapolis! I just had to go, because it would have been cheaper and less travel compared to going to another state for this training. 

Now you might be wondering what this training is about. It is focused on combating the obesity epidemic in youth and the goal is for RDs to be able to learn more about this issue and be better equipped to work with patients to help them become healthier. To complete the certificate program you have to complete required readings, complete a pre-test (score minimum of 80%), attend the 2 1/2 day program and then complete a post-test (scoring a minimum of 80%). At the end of all this you get to claim this certified training on your resume and gain useful knowledge in this specialty area. 

So even if you aren't an RD, I did learn some interesting information that you might find interesting. 

• Children ages 2-19 - 32% of them are obese and 21% of children ages 6-10 years are living in food insecure homes.
• It is projected that by the year 2072 - 80% of everyone in the United States will be obese (BMI >30kg/m2). 
• 60% of children 10-14 years old have a TV in their bedroom. Research has shown that kids gain 1 extra pound per year when they have a TV in their bedroom compared with children who didn't have a TV in their bedroom. 
• Children are often the main target for intense and aggressive food marketing and advertising efforts. Often this is NOT for healthy, food options.

I know some of those statistics are depressing, but I think it helps to realize how big of a problem this is for children and this isn't a problem that goes away in adulthood. This weight gain trend often continues as the child gets older and continues to be a problem throughout the child's entire life. 

There are lots of things that we (as a community) can do to help our youth be healthier now and for the future. 

• Make an effort with your children to limit screen time, get outside a move more and purchase healthy food for your home. 
• Try to eat out less and make being healthy an entire family commitment. 
• Support health/wellness initiatives in the local school systems. 
• As a parent or caregiver, demonstrate healthy behaviors for your children. 

I wanted to share this video from the FNV Campaign (Food and Veggies) that is a partnership from the Healthier America and Let's Move Campaigns to help encourage healthier food marketing to Americans. I just wanted to leave you on that note and encourage you to make healthy choices for yourself and your children. 

Being a clinical dietitian in the NICU

I have been thinking about writing a blog post about my job as a Registered Dietitian in a Neonatal Intensive Care Unit. I know some people have no idea what I do on a daily basis and even some of my family may be confused. 

But to start off this explanation we need to go back to high school. I met with a Dr Fadley who was a therapist of sorts. He meets with people, has you take a test and that then determines future occupation based on your interests/skills. He told me that I could go into dietetics, but it would be tough (and it was), but I would be best suited for special education and being a teacher. I kind of blew him off and thought that was ridiculous. 

Well here looking back about 10 years later ... I think Dr Fadley spoke some truth. I have a passion for helping those that can't always help themselves. I love working with people who have faced challenges in their lives - mental, emotional or physical. I have a special place in my heart for being that care giver and helping people. Looking back I can see that displayed in many ways, but I think in my current job it helps to sums up what I do every day. I help to provide care for the littlest of babies who aren't suppose to be born yet. All of us in the neonatal world, work to help them beat the odds and have a chance at life. Being able to be part of that team, who works to give each of these babies a fighting chance is amazing. I love it! 

My specific role as the dietitian is to calculate the nutritional needs for our neonates. I work with a team of neonatologists, speech therapists, nurses and dietary technicians to make sure that our babies are getting the best recipe for feedings to meet their  unique needs.  More goes into these calculations than just crunching numbers. As the dietitian, I have to be aware of various medical conditions that could have an impact on their nutrient absorption/metabolism. This can be a complicated process if you have a baby with renal failure, a cardiac condition or a GI issue. Each of our patients, is like a puzzle that we are working on figuring out during their hospital stay. 

In addition to charting on each of these patients, I help to oversee the formula room. This is the place in our hospital where all the feedings are made by dietary technicians. We make 24 hours worth of feedings for all of our patients and we help to make sure that these techs are doing their job right. These techs are valuable part of our team and help ensure that the nutrition plan the dietitian comes up with is put into action. 

I wanted to share my job with you, because it is different. Hopefully this is a helpful little snap shot into the world of neonatology through the eyes of the dietitian. It is an amazing place to be and I enjoy being able to play a small role in so many children's lives. 

Certified Specialist in Pediatrics

I got the letter. I have been waiting to hear how I did on the Academy of Nutrition and Dietetics National Board Exam for the Certification in Pediatrics. I took the exam back in November, just prior to Thanksgiving. I had been waiting while they graded all of the exams and determine who passes. I felt better about this exam and after reviewing some flashcards for the exam I felt like I had a better handle on the material. 

For those of you that may be confused about what this means ... the accreditation body for the dietetics profession is the Academy of Nutrition and Dietetics. They have several certification exams that you can take in a variety of speciality areas - for example Nutrition Support, Diabetics, Pediatrics, Sports Nutrition, etc. To be eligible to take these exams you must complete a set number of practice hours. For the Certification in Pediatrics it was 2,000 contact hours with pediatric patients. You also must have at least 2 years of experience as a Registered Dietitian. Once these requirements are met you are eligible to sit for the exam. Once you pass the exam you can place these certification letters after your name. I have been wanting to obtain these credentials for several years, ever since I developed a love for pediatrics and working with families in a nutrition setting. 

I got my letter this past week, congratulating me on passing this exam. Now I can sign my name Anna Busenburg, RD, CSP. It is quite exciting to see all the hard work, hours of studying, finally pay off!