Pediatric Nutrition: Social and occupational outcomes of undernourished children

Faculty: Juliana Gutierrez, OTD, OTR/L SWC


Project Objectives
  • To provide hands-on therapeutic interactions supporting daily activities within an inpatient nutrition unit, including feeding, caring, playing and therapeutic activities
  • To understand the social and occupational impact of an inpatient infant nutrition unit in Guatemala
  • To explore children’s occupations within the Hospital Obras Sociales and within the context of Guatemala’s culture
  • To recognize the impact of nutritional and developmental deficits on social and occupational justice in relationship to Guatemalan political and social history
  • To understand the relationship between nutrition, early childhood developmental trajectories and occupational capacity
  • To engage with Guatemalan community members and professionals to extend the student’s understanding of attitudes and practices regarding  feeding, nutrition and developmental milestones
  • To become immersed within the culture of Guatemala and the the pediatric nutrition unit to collaborate in the development of intervention strategies that go beyond the clinic context to strengthened sustainable services appropriate for their social context
Project Activities

Approximately 47% of all children in Guatemala experience chronic undernutrition, which is one of the highest rates in the world. Undernutrition has a profound impact on early childhood developmental trajectories. Through direct hands-on experience on an in-patient infant nutrition unit, the Pediatric Nutrition group will focus on the social, political, and economic determinants of child development in Guatemala and the impacts of chronic undernutrition on childhood occupational capacities. The group will specifically consider the clinical outcomes and social implications of local infant and child feeding practices and norms of development, including play opportunities.

The Pediatric Nutrition group will gain hands-on experience on an infant nutrition unit at Obras Sociales Hermano Pedro, a Catholic charity hospital located in Antigua, Guatemala, serving low-income families throughout the country. The infant nutrition unit is a restricted-entry in-patient medical unit with 25-30 beds, served by a specialized team of nurses, nutritionists, and volunteers. The unit is populated by infants with cleft palate awaiting surgical reconstruction; severely malnourished infants presenting with failure to thrive; and infants and children with neurodevelopmental disabilities requiring special feeding.

Students will participate in a hands-on experience that will include supporting feeding and mealtime of children in the unit and evaluating children developmental, nutritional, socio-emotional and occupational participation. Observational methods and chart reviews will be used for assessing nutritional, social and occupational status, and students will experience feeding techniques, plan and implement therapeutic approaches based on play and sensory motor intervention strategies. Students will be guided in how to observe and understand the cultural dimensions of early childhood development and explore them in light of the social determinants of health discussed in the core curriculum.  The group will develop case study analyses of developmental trajectories of children on the clinical unit, describing in detail feeding, developmental and participation progress of the children. These case analyses will be further examined in comparison to the children found within the local community, which will be elicited through informal engagement with the community and qualitative research methods.

Students will participate as a group in 3-4 half-day sessions per week at the infant nutrition unit at Hermano Pedro. There will be time each week for supervised hands on work with infants and children, as well as general debriefing and discussion. Students can expect to spent time outside of clinic time on group meetings and preparation of their final case study reports.

Key competencies gained will include:  Critical thinking and analysis of social and occupational outcomes of poor nutrition and the impact on occupation and neurodevelopment; knowledge on feeding techniques, sensory-motor and play intervention strategies; ability to use growth parameters/measurements to understand the impact of nutrition on physical development; and qualitative research methods and analysis, including case study methodology.