Pediatric Assessment and Nutrition Screening

Pediatric assessment encompasses a comprehensive evaluation of children's health.
Nutritional screening tools include the Nutrition Risk Score (Paris tool), subjective global assessment, Strongkids, STAMP, and PYMS.

The first line/basic assessment involves nutrient intake, clinical assessment and anthropometry.
The second line consists of biochemistry and haematology tests.
Research tools like body composition studies, immunology and functional tests, including isotope studies, are sometimes crucial but can be inappropriate for pediatrics.

Head circumference is essential for children under 2 years.
Weight measurement should ideally involve children who are naked or wearing a dry diaper, using calibrated digital scales. More frequent measurements are crucial for sick infants.
Height measurement for children under 2 years should use the supine position, whereas for older children/infants, the standing position is appropriate. Sick infants should be measured monthly.

Recumbent length is the preferred method for measuring length until the child is 24 months old or cannot stand.
The length board or Perspex measuring board should be used.
Remove shoes, socks, braids, and hair ornaments.
The mother should assist in holding the child's head.
The child's eye socket should be perpendicular to the board and shoulders/buttocks positioned along the board without pressure on the knees.
The measurement should be recorded to the nearest 0.1cm.

Height should be measured in children two years old or above and capable of standing.
The general height is typically 0.7cm less than the recumbent length.
Children below two years, but unable to lie down for length measurements, should have 0.7cm added to their height measurements to convert to length.
Children above two years and incapable of standing should have 0.7cm subtracted from their recumbent length measurement to convert to height.
The feet should be kept slightly apart in the measurement.
The child's head, shoulders, buttocks, and heels should touch the board.
The measurement should be taken to the nearest 0.1cm.

Proxy measurements, such as lower leg length or knee-heel length, are sometimes used to estimate growth.
Formulas for stature calculation in children are available.
MUAC can evaluate the health of sick children.
Waist circumference and insulin resistance can assess dyslipidemia.
Skinfold thickness is used but can be unpleasant for some children.
Bioelectrical impedance can assess normal children, yet is unsuitable for sick children.

Head circumference measurements are crucial until the age of 36 months (currently recommended until 24 months).
The measurements occur around the back of the head, just above the eyebrows and ears.
The maximum circumference is measured.
Recording should be done to the nearest 0.1cm.
Head circumference abnormalities can point to underlying diseases and not necessarily malnutrition.

Growth charts should be used to plot measurements regularly for interpretation.
Thrive lines (5% and 95%) help interpret rapid or slow growth rates.
- The 5% line marks the slowest growth rate.
- The 95% line marks the fastest growth rate.

BMI can be calculated using height and weight measurements; using weight(kg)/height(m squared).
It is crucial to avoid BMI measurements in children under 2 years of age. Their rapid weight gain is a better indicator of future health issues.

The WHO uses z-scores to categorize malnutrition and obesity; -2SD for malnutrition, and +2SD for obesity.
Measuring height for age, height-age, and weight-for-height assists in assessing malnutrition status, particularly for short children.
The Waterlow classification system aids the assessment of children with severe malnutrition.
Malnutrition is characterized by z-scores (weight and height calculations).

UK growth charts provide percentile and z-score values.
Z-scores of +2SD correspond to the 98th percentile and -2SD to the 2nd percentile.
A z-score of 0 corresponds to the 50th percentile.

A medical history and physical examination are part of a comprehensive clinical assessment.
Identifying medical, social, or environmental risk factors for nutritional problems, including information about parental food knowledge and financial resources, are included.
Clinical signs of poor nutrition, such as altered hair, skin, eyes, lips, tongue, teeth, gums, face, nails, subcutaneous tissues, muscles, and bones, may appear late in the development of deficiencies. Thus, their absence shouldn't falsely suggest the absence of a deficiency.

Table 1.7 details various biochemical and haematological tests for nutrient assessment and their normal values in children.
Normal values in children for each nutrient are indicated.

Assessment methods for dietary intake include dietary recall, food diaries (quantitative food records, food charts recorded over days, weighed food intake over days, and frequency questionnaires).
Observe feeding situations to evaluate milk intake in breastfeeding infants. Test weighing gives the most accurate measurements of milk intake in breastfeeding infants.
24-hour recall, Estimated food diaries, Weighed food diaries, and Food frequency questionnaires are among the many methods for recording dietary intake.

Tables show average weight gain in boys and girls throughout the first year of life.

Infants should be allowed to feed on demand initially but parents often prefer routines.
Frequency may shift from 4-hourly to 5 or 6 daily feedings when the infant is 4-6 weeks old.
Fluid intake should remain around 150ml/kg to supply adequate fluid, energy, and nutrients.
Do not exceed 1200ml of feed per day in normal infants to prevent vomiting and excessive energy intake.
Sick infants may need smaller, more frequent feedings, with adjustments based on their clinical condition.
Breast-fed infants tend to regulate their own intake.
After six months, follow-up milk or formulas are used.

Overweight children may need less fluid than expected, and their actual weight is used for calculations. The actual weight should match the height centile in this case.
Underweight children require additional energy and protein in their feeds for catch-up growth.
Supplementation may be necessary where growth is too slow or impacted by restrictions.
Carbohydrate concentrations (guidelines) vary by age.
Fat provides 9 kcal/g and is preferably added as long-chain fat for optimal digestive health.
Tables schedule the addition of energy supplements to formulas.
Protein can be added as whole protein, peptides, or amino acids, but should be added slowly to prevent a rapid increase in intake.

Weight-for-age, length-for-age, and weight-for-length z-scores help classify malnutrition, using various tables for children from birth up to two years.
Arm fat and arm muscle area measurements can aid the assessment of nutritional status (arm muscle area and arm fat area).
The classification of malnutrition is categorized into categories such as acute and chronic, as well as grades 1,2,3. Dietary intake should be evaluated in concert with physical findings and other measurements.