First, I am not a Registered Dietitian (RD) or Nutritionist; I am a Family Medicine physician with a large pediatric practice. I field questions on a daily basis from parents about what/when/how their infants should eat, advantages of breastfeeding, solid food myths, etc. Occasionally, one of the infants in my practice is failing to thrive or crossing multiple lines on the growth chart.
At my institution we possess a robust and eager to assist nutrition department complete with a RD in our residency’s PCMH clinic and access to Peds Nutrition services. PediatricRD is clearly designed more with them in mind than the average primary care provider. The app was designed at the University of Michigan(UM) and continues a trend of apps released from the UM. We have reviewed many other UM apps here on iMedicalApps including their excellent Anticoagulation Toolkit, The Eyes Have It, Return2Play, Neurolocalizer, Nerve Whiz, and UMSkinCheck. Although somewhat narrowly focused, PediatricRD has a lot to offer for both outpatient and inpatient care of pediatric patients with nutritional concerns.
Let’s use a clinical scenario to illustrate how you may use PediatricRD in the hospital setting. You are already 30 min behind in clinic, when you begin to see your next patient, a 6 month old female who presents with her parents for her 6 month well child exam. You quickly note that this previously exclusively breastfed infant is now below the 5th percentile on the growth chart in your EMR. The mother states she noticed her milk supply decreasing so started giving the infant water and rice milk “to make up the difference”. At this time, you tell your nurse to let your upcoming patient know you are going to be late.
When you first open the app, you see six named icons breaking the app into its different subject areas: anthropometrics, growth charts, predictive equations, peds malnutrition tool, formulas, and parenteral nutrition. There is a search symbol at the top to gain more rapid access to specific topics in the app, but that is pretty much it. There is not a section describing the app or its developers or any instructions about how to use it. Each section of the app does contain references for its content.
Clicking on anthropometrics (which is the study of human measurement), reveals a dropdown of topics ranging from alternate length measurements to growth chart information. You utilize the growth chart information to assist in ensuring the child, which had been breastfed until the last week, is charted on the WHO as opposed to the CDC charts your EMR uses since those are designed for older infants and includes formula fed infants. At this point the infant is back on the growth chart, but still has lost significant velocity. This section of the app does not include growth chart input. The other measurements included here are likely more useful to an RD than MD/DO. Unfortunately, the app gives formulas but they don’t actually “work”—for example, the BMI calculator shows the formula, but you cannot input any data to calculate an actual BMI. I also noticed the “back” button on the app was not particularly responsive and instead of another “back” button, you have to hit the “home” button to get back to the main screen. This could be more intuitive and responsive.
Next, you turn to the growth charts section to illustrate your concerns with your patient’s parents. The app lists the most common growth charts including the WHO, CDC and Fenton (used for preemies). At first glance you again can’t chart your patient, but scrolling all the way down this section of the app you discover the “Plot Your Patient” feature. Inputting the data, you show the parents the “corrected” growth chart. In reality, I found this feature buggy. It was difficult to enter the wt and ht data. Once I entered the data, I couldn’t choose which growth chart I wanted to see the data plotted upon. You may want to stick with other growth chart apps if you want to do this on your phone until this is fixed.