Dietitians

Question and Answer:

Registered Dietitian: What to Expect

1. What is a Registered Dietitian and what service do they provide to clients?

A Registered Dietitian (also referred to as a dietitian or RD) is a Regulated Health Professional with extensive knowledge of food and nutrition. Dietitians are held to professional standards and are regulated in each province; in Ontario the regulatory body is the College of Dietitians of Ontario (CDO). The CDO works to protect the public. Dietitians are accountable to the college to provide nutrition services that are competent, safe, and ethical.

A dietitian is trained to assess the nutritional health and the risk of malnutrition of a person by collecting important information such as:

  • Diet history – e.g. what one usually eats, when, where, & how
  • Physical measurements – e.g. height & weight
  • Relevant blood work values – if applicable
  • Gastrointestinal (GI) issues or symptoms
  • Medication & supplement use
  • Social & family supports

 

This information is used to assess nutritional health and together with the client, help create a nutrition care plan to meet their nutritional goals and needs. Registered Dietitians use current research to help make nutrition recommendations.

2. What is the difference between a dietitian and a nutritionist?

The term “nutritionist” is not regulated in Canada. This means that there are no education standards to use this title.

The title of “Registered Dietitian” (including “dietitian” and “RD”) is protected and only those who have successfully completed regulated training programs and are registered with the governing college can use this title. Registered Dietitians are the only food and nutrition professionals recognized to work in the publically funded health care system.

Registration with the College of Dietitians involves completion of both an accredited university program in Food and Nutrition, and an accredited dietetic internship. All Registered Dietitians must write and pass the Canadian Dietetic Registration Exam. All Registered Dietitians are also required to participate in an annual quality assurance program with the College of Dietitians of Ontario.

For more information please visit: www.collegeofdietitians.org or www.dietitians.ca

3. Do dietitians specialize in providing service/support to people with ASD?

There is no specific dietetic training providing a specialization to work with individuals with autism. Although there are some educational resources available, most dietitians gain the skills required to support individuals with Autism Spectrum Disorder (ASD) through experience.

4. What questions should I ask when looking for a dietitian for my child?

The nutritional concerns of individuals with autism are unique. It is suggested that one works with a Registered Dietitian with previous experience addressing the nutritional needs of individuals with autism.

It is important to ask a potential Registered Dietitian about their past experience and if they have worked with individuals with autism or similar disorders. For example, asking whether the dietitian has had any experience with sensory feeding difficulties (sensitive to the tastes, textures, and smells of food), food chaining (using already accepted foods to transition to new types of food), and sensory play (activities that use and stimulate the senses). Another helpful question to ask is whether the dietitian can either provide a referral, if required, to other health professionals like an Occupational Therapist or Family Counsellor, or liaise with the individual’s General Practitioner to provide such referrals. A team approach is the best way to support an individual with ASD.

5. When should a dietitian be contacted to provide service?

As with any child, the diet of a child with ASD is best when it is well balanced. Based on the research at this time, there is no specific diet those with ASD must follow. Ensure your child is consuming a variety of food groups to support their growth and development. If this is challenging or you are considering starting a specific diet, meet with a Registered Dietitian.

A dietitian should be contacted if:

  • There are poor growth patterns – including too much or too little weight gain
  • One or more food groups are completely avoided – The four food groups include: vegetables & fruit, grain products, milk & alternatives, and meat & alternatives
  • A hunger strike is started – e.g. individual stops eating favourite foods, or stops eating for days
  • There is interest in starting complementary or alternative nutrition – e.g. a special diet
  • There is severe constipation affecting intake – e.g. can be related to insufficient water or fibre intake
  • There is concern regarding feeding or nutrition from parents and/or caregivers

 

In general, if the child is growing well and the eating patterns work for the family then there is often little need for concern. However, if parents are concerned, seeking the help of a Registered Dietitian to assess the overall dietary intake of the child can be helpful to determine if there are nutritional deficiencies.

6. What does the research say around getting a dietitian involved to support a person with ASD?

According to a 2010, consensus report published in the journal Pediatrics, having the support of a physician or dietitian can help minimize the risk of malnutrition by working in collaboration with parents and/or caregivers to ensure optimal nutritional health.

A 2012 report from Dietitians of Canada, regarding healthy eating and mental health promotion, showed that there is a role for Registered Dietitians when GI issues affect the nutritional intake of the individual. It was also noted that nutrition is not typically used to treat the symptoms associated with autism, however a dietitian can assist with concerns sometimes experienced by those with ASD including: limited food intake or intake that is not nutritionally balanced, weight concerns, potential interactions between medications and foods, the eating of non-food items, and connecting families with community support systems.

7. Are there key topics parents of children with ASD are inquiring about?

There is significant interest from parents in using nutrition or nutritional supplements to treat the symptoms of ASD, with particular interest in gluten and/or casein free diets. There is currently insufficient evidence to support the introduction of restrictive diets to affect behaviour, as there is the added risk of developing nutrient deficiencies. The ultimate goal is to include as much variety as possible to ensure optimal nutrition and avoid complicating meal times. However, if a restricted diet is to be introduced, it is best initiated under the supervision of a dietitian or physician to ensure nutritional adequacy. Therefore, it is recommended that a restrictive diet (e.g. gluten and/or casein free) not be started until after you have met with a Registered Dietitian.

8. How can a dietitian work with other professionals who are supporting my child, such as a Behaviourist, Occupational Therapist or Paediatrician?

Support for individuals with ASD is best provided in the context of a team. Dietitians work collaboratively with other health care professionals to provide optimal care for clients. Therefore, with the consent of the child and/or caregiver, the dietitian can communicate with other members of the child’s health care team to relay the nutrition care plan and coordinate therapies. For example, the dietitian can communicate sensory or textural issues with the Occupational Therapist to allow for complementary therapy to address these aversions.

9. What can I expect when receiving services from a dietitian?

Dietitians are trained to assess and evaluate the dietary intake of an individual in the context of their unique nutrition requirements – e.g. to support growth and development. In general, a dietitian will ask about the individual’s typical eating patterns through questions of what, when, where, and how. The dietitian may also inquire about other clinical symptoms (such as GI issues) or conditions that can affect intake or nutritional needs, including the use of medications or supplements. Together, this information, alongside the nutritional goals of the individual with ASD, will be evaluated and a nutrition care plan will be developed.

It can also be expected that a dietitian will determine whether there are gaps in the child's diet and use the child's preferences to introduce greater food variety through food chaining or other intake strategies. For example, if a child will only eat pasta without sauce, other healthy bland choices can be explored (e.g. small pasta without sauce, followed by whole wheat pasta, then quinoa without sauce.)

A dietitian may also be able to identify which eating behaviours are typical of all children, for example picky eating, as opposed to behaviours resulting from the symptoms of ASD.

Also, based on the ability of the individual with ASD, the dietitian may identify an appropriate level of participation in food related activities. Those individuals with a greater capacity for involvement should be encouraged to be active in food preparation to foster the development of basic food skills.

You should feel free to ask questions to clarify information and offer your ideas, collaborating with the dietitian, to achieve the nutrition goals. The dietitian will monitor the plan, and if it is not working, together you can discuss new ideas.

10. How much should I expect to pay for the services of a dietitian?

The fees for dietetic services range based on location and the services provided. In general, one can expect an initial assessment to cost between $85-150 and last approximately one hour; and follow up appointments can range from $50-90 and typically last about 30 minutes. Some private insurance plans provide coverage for dietetic services.

For quick food and nutrition related questions, such as questions about food groups or portion sizes, Ontario residents have free access to a dietitian, through EatRight Ontario. You can either speak to a dietitian directly by calling the toll-free number 1-(877)-510-5102 or email your questions through www.eatrightontario.ca. There are also a variety of nutrition articles, recipes, and resources available on their website.

11. How do I find a dietitian in my area?

Two ways to begin your search for a dietitian in your area are through the Provider Listings available on the Autism Ontario Spirale database, or through Find A Dietitian available on the Dietitians of Canada website.


Completed by: Laurie Wybenga, RD – In consultation with Stefania Palmeri, RD

Laurie Wybenga is a Registered Dietitian with a passion for nutrition education. She completed her dietetic internship at St. Michael’s Hospital in Toronto, and her undergraduate degree at Ryerson University. Laurie enjoys working with clients individually, but also enjoys advocating for the role of dietitians and accurate nutrition information in public forums. Her research to date includes exploring the role of nutritional supplements in preventing malnutrition in hospital, and the use of probiotics in managing tube-feeding related diarrhea.

Stefania Palmeri works as a Registered Dietitian at The Medcan Clinic in Toronto, and her own dietetic practice, in Whitby, Ontario. She completed both her undergraduate degree and Master’s degree in nutrition communication at Ryerson University. Stefania has worked with children with feeding difficulties, including those with autism, during her dietetic internship at North York General Hospital, in Toronto. She continued to work at this clinic for several years, and now sees paediatric clients in day-to-day practice. Her past research has included studying the rates of nutrient deficiencies amongst children with autism and bowel issues, and how nutrition information is communicated in children’s storybooks.

Additional information from: PEN – Practice-Based Evidence in Nutrition (Dietitians of Canada); and Dietitians of Canada Learning On Demand Seminar by Patricia Novak, MPH, RD.

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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