Untitled Quiz

Pediatric Assessment

• Pediatric assessment involves a medical history and physical examination.
• Medical history identifies medical, social, and environmental risk factors for nutritional problems.
• Clinical signs of poor nutrition are revealed during the physical examination, appearing late in the development of the deficiency.
• Absence of clinical signs doesn't imply a lack of deficiency.

Nutrition Screening

• Tools include Nutrition risk Score (Paris tool), subjective global assessment, Strongkids tool, STAMP, and PYMS.

Assessment Procedures

• First Line:

  • Nutrient intake
  • Clinical assessment
  • Anthropometry

• Second Line:

  • Biochemistry
  • Hematology

• Research tools (may not be suitable for all pediatric cases):

  • Body composition studies
  • Immunology
  • Functional tests
  • Isotope studies

Anthropometry

• Head circumference: Measured in children under 2 years of age.
• Weight: Measured ideally with a child naked or in a dry diaper using a calibrated digital scale. More frequent measurements for sick infants.
• Height: Measured supine (under 2 years) or standing. Sick infants are measured monthly.

Measurement of Length

• Recumbent length: Used for children under 2 years. May extend to 36 months if unable to stand.
• Measured using a Perspex board.
• Procedure involves removing shoes, socks, braids, and hair ornaments.
• The head should be supported by the mother (if possible).
• Eye socket should be perpendicular to the board.
• Shoulders and buttocks should touch the board, and legs should be straight. Apply gentle pressure to the knees (for newborns).
• Measurement is taken to the nearest 0.1 cm.

Measurement of Height

• Used for children over 2 years and able to stand.
• In general, height is approximately 0.7 cm less than recumbent length.
• Add 0.7 cm if the child is under 2 years and cannot lie down.
• Subtract 0.7 cm if the child is over 2 years but cannot stand.
• Feet should be slightly apart, and many body contact points (e.g. head, shoulders, buttocks, heels are used when measuring to aid comfort).
• Measured to the nearest 0.1 cm.

Proxy Measurements

• Measurements like lower leg length or knee-heel length can be used as proxies for growth.
• Formulas for calculating stature (height) are available.
• MUAC (mid-upper arm circumference) helps assess the health of sick children.
• WC (waist circumference) and SFT (skinfold thickness) are useful for assessing dyslipidemia and insulin resistance, respectively, in overweight children.
• Bioelectrical impedance is helpful for measuring normal children but not necessarily sick children.

Head Circumference

• Relevant up to 36 months of age (now 24 months).
• Growth is rapid in the first 12 months and slows until 36 months.
• Measured just above the eyebrows, above (not over) the ears, and around the back of the head.
• Measures the maximum circumference, with measurement to the nearest 0.1 cm.
• Abnormal head circumference may be due to illness rather than malnutrition.

Growth Charts

• Plotting measurements on relevant growth charts is important.
• "Thrive lines" aid interpretation of slow or rapid weight gain.
• The 5% thrive line marks the lowest rate of normal weight.
• Weight gain parallel or below the 5% line implies abnormally slow growth.
• The 95% thrive line marks the maximum rate, and a parallel or faster increase indicates abnormally rapid gain.

BMI

• BMI (body mass index) is calculated using weight (kg) divided by height (m²).
• BMI is not recommended for children under 2 years due to rapid changes in this age group. Weight gain is a better indicator of future obesity and overweight in this age group.
• Chronic undernutrition can be masked by using BMI.
• BMI is a relative index that does not indicate body composition.

Anthropometric Indices and Nutrition Status Classification

• The WHO uses z-scores of weight to identify moderate malnutrition or obesity. z-scores of -2 SD and +2 SD are used for moderately malnourished and obese children, respectively.
• Calculating height for age, height age, and weight for height helps assess nutritional status, especially helpful when children are short for their chronological age.
• The Waterlow classification is useful for assessing malnutrition in children in the UK.

UK Growth Charts

• UK growth charts use percentile and Z-scores.
• +2 SD corresponds with the 98th percentile.
• -2 SD corresponds with the 2nd percentile.
• Z-score 0 = 50 percentile

Clinical Assessment

• Clinical assessment involves a medical history and a physical exam.
• The medical history identifies potential medical, social, or environmental risk factors including parental knowledge and finances for food purchase, and presence of underlying diseases and treatments.

Physical Signs of Nutritional Problems

• See table summarising clinical signs and possible nutritional deficiencies.

Dietary Intake

• For children above 2 years, dietary assessment uses the same methodology for adults.
• Options include recall diet history, quantitative food diary over several days or a food frequency questionnaire.
• Observing feeding patterns can be particularly useful.
• Breast milk intake can be assessed by weighing. Accurate scales and recording all feeds for a 24 hour period are necessary to avoid underestimating or inaccurately recording intake volume.

Dietary Assessment Methodologies

• See table summarising strengths and limitations of various methodologies.

Expected Growth in Childhood

• See table summarising average weight gain in boys and girls in the first year.

Fluid Requirements

• Formula-fed infants should be fed on demand.

• Many infants take feeds every 4-6 hours between ages 4 and 6 weeks but may feed more frequently.

• Infants may sleep longer throughout the night and skip a feed.

• Maintain fluid intake at ~150 mL/kg.

• Limit total intake to 1200 mL per 24 hours to avoid vomiting or high energy intake.

• Sick infants may require more frequent and smaller feeds.

• Breastfed infants regulate their intake based on milk demand and feeding patterns

Supplementation

• Supplements may be used to improve nutrition of infant formula in cases where infants are growing slowly or have restricted caloric or fluid intake.
• Care is needed to avoid highly concentrated formulas

Carbohydrate

• Carbohydrate provides 4 kcal/g (16 kJ/g) as a glucose polymer instead of monosaccharides or disaccharides to reduce gut osmotic effects.
• Add glucose polymers incrementally, 1% every 24 hours, until loose stools or intolerance develops.
• Tolerance varies with infant age and gut maturity.

Fat

• Fat provides 9 kcal/g (37 kJ/g).
• Long chain fat emulsions are preferred over medium chain.
• Add fat incrementally (1% every 24 hours) to avoid exceeding the tolerated levels.

Energy Requirements

• Use the "catch-up growth formula" for children who need to increase their intake of caloric or protein based on the RDA for age.

Protein

• Protein can be added to feeds as whole proteins, peptides, or amino acids.
• Use small increments to minimize risks of intake increases.

Interpreting Results

• See Table summarising z-score interpretation for length/height, weight-for-age, and BMI-for-age.
• Interpretation of these measures involves the various indices including BMI-for-age, length-for-age, and weight-for-age.

Anthropometry (Arm Fat and Muscle Area)

• See table for calculations for arm fat and muscle area.
• This is used, for example, to detect malnourishment.