Pediatric Nutrition PDF

10/7/2024 Pediatric Nutrition Nutritional Assessment of Pediatrics 1 Pediatric Nutrition Goals 1. Decrease the incidence of morbidity and mortality associated with nutritional problems in our pediatric patient population. 2. Improve patient clinical...

10/7/2024 Pediatric Nutrition Nutritional Assessment of Pediatrics 1 Pediatric Nutrition Goals 1. Decrease the incidence of morbidity and mortality associated with nutritional problems in our pediatric patient population. 2. Improve patient clinical outcomes by providing timely, optimum, safe, and cost-effective nutrition through either the oral route or for those children who are critically or chronically ill, using tube feedings or parenteral nutrition support. 3. Identify patients who will benefit from nutrition intervention. 4. Provide patient education in the areas of specialized or therapeutic diets, or for specialized enteral or parenteral nutrition support. Islam Al-Shami 2024 2 2 1  10/7/2024 Routine Nutrition Care for pediatrics GOALS: 1. Maintenance of body functions (growth & development). 2. Maintenance of body activity. 3. Healing (if needed). 4. Disease management/treatment. Islam Al-Shami 2024 3 3 Estimate of Pediatrics Nutritional status 1. Nutritional Screening 2. Comprehensive Nutritional Assessment 3. Interpretation of Nutritional Assessment 4. Nutritional Intervention 5. Follow-up plan Islam Al-Shami 2024 4 4 2  10/7/2024 Nutrition Screening ▪ RDs screen pediatric patients to determine those at nutrition risk ▪ The initial screening is based on the presence of the following: ▪ Special diet or formula ▪ Poor oral intake for > 5 days ▪ Pressure ulcer(s) or poor wound healing ▪ Burns > 15% of total body surface area ▪ Problems chewing or swallowing ▪ Use of specialized nutrition support: enteral or parenteral ▪ Current diagnosis of malnutrition, cystic fibrosis, failure to thrive, or new-onset diabetes mellitus Islam Al-Shami 2024 5 5 Comprehensive Nutrition Assessment High-Risk Nutrition Diagnoses and Conditions: ▪ Patients on nutrition support ▪ High-risk diagnoses or conditions: Anemia, Burns, Cancer, Congenital heart defects, Cystic fibrosis, Diabetes mellitus, Failure to thrive, Gastrointestinal disorders, Inflammatory bowel disease, Malabsorption syndromes, Preterm Infants ▪ Weight below or above standards: Weight/height < 3rd%-ile on age- and disease-appropriate growth charts or > 95th-ile, or Recent weight loss of > 10% of usual body weight ▪ Catabolic state: sustained fever, major organ failure ▪ Diet order and patient intake are inadequate for requirements: NPO > 3 days in previously malnourished children or NPO > 5 days in previously well-nourished children, without parenteral or enteral nutrition, Patients on clear or full liquid diets for > 5 days Islam Al-Shami 2024 6 6 3  10/7/2024 Nutritional Assessment of Pediatric The assessment of body weight, growth, adipose tissue, skeletal muscle, visceral protein stores, and cellular immune function can determine nutritional status Islam Al-Shami 2024 7 7 Components of Nutritional Assessment 1. Growth assessment and anthropometric measurements 2. Medical, developmental, social, and personal history 3. Nutritional intake history and history of food allergies 4. Laboratory evaluation of biochemical and metabolic changes 5. Review of nutrition-focused physical examination findings 6. Educational needs and potential barriers to learning Islam Al-Shami 2024 8 8 4  10/7/2024 Age Groups Islam Al-Shami 2024 9 9 INFANT GROWTH ▪ The intrauterine environment and maternal nutrition are primarily reflected in the growth parameters at birth and during the first few months of life, after which genetic and environmental factors exhibit a stronger influence. ▪ Many infants will significantly change growth percentiles or z-scores for weight and length during the first 2 years of life ▪ Term neonates can lose up to 10% of their birth weight during the first few days of life and should get back to their birth weight by days 10–14. Then infants established a pattern of weight gain during the first year of life. ▪ Expected weight gain during infancy is approximately 30 g/day from age 0 to 3 months, 20 g/day for ages 3 to 6 months, and 10 g/day for ages 6 to 12 months. Islam Al-Shami 2024 10 10 5  10/7/2024 INFANT GROWTH ▪ Infants should roughly double their birth weight by 4 months of age and triple their birth weight by 12 months of age. Weight gain slows after the infant’s first birthday. ▪ Normal linear growth in infants is approximately 10 inches (~25 cm) during the first year of life. ▪ Feeding methods can impact the weight gain patterns: Breastfed infants typically gain weight more rapidly during the first 3– 4 months of life than formula-fed infants ▪ By age 1– 2 years, the weights of breastfed and formula-fed infants are similar. ▪ It is important to correct growth parameters for gestational age in preterm infants ▪ The World Health Organization suggests correction of weight, height, and head circumference until age 2– 3 years for children born prematurely Islam Al-Shami 2024 11 11 Childhood GROWTH ▪ Children gain approximately 2 kg/year between age 2 years and puberty. ▪ They typically gain 4 inches (~10 cm) in length/height during the second year of life, 3 inches (~7.5 cm) during the third year of life, and 2 inches (~5 cm)/year between age 4 years and puberty. ▪ With increasing height and slowed weight gain, toddlers and preschoolers grow taller and leaner. ▪ Of note, growth during this period is pulsatile, consisting of periods of rapid growth separated by periods of minimal growth. ▪ There is also normal deceleration of height velocity before the pubertal growth spurt during adolescence. Islam Al-Shami 2024 12 12 6  10/7/2024 ADOLESCENT GROWTH ▪ Puberty refers to the physical changes that occur during adolescence, including a significant growth in stature. with some individual variation in sequence and timing of onset (between 8 and 13 years in girls and 9.5 and 14 years in boys). ▪ Approximately 20% of adult height growth occurs during puberty, though the pattern of height buildup can be highly variable. It can be steady growth or periods of rapid growth interspersed with periods of slow growth. The typical pubertal growth pattern involves a phase of acceleration, followed by a phase of deceleration, and ending with the eventual cessation of growth with the epiphyseal (growth plate) closure. ▪ The timing of the growth spurt varies by sex, occurring 2 years earlier on average in females than in males. Islam Al-Shami 2024 13 13 Measurement of Growth ▪ Accurate measurements of growth are essential for growth assessment. ▪ Growth can be measured in two ways: ▪ Current, attained growth relative to same-age peers ▪ Growth velocity, which reflects the change in a growth parameter over time. Islam Al-Shami 2024 14 14 7  10/7/2024 Measurement of Growth ▪ Weight, Recumbent length ( 2 years) for age, Head Circumference ▪ Growth charts are used to evaluate the following anthropometric measurements: Length/Height for age: indicates chronic undernutrition and growth failure Weight for age: overall nutritional status; indicates acute malnutrition Weight for height: distinguishes wasting from dwarfism Head circumference for children under the age of 3 years BMI for 2-20 years ▪ Specialized growth charts for specific disease states; Down syndrome, Cerebral palsy Islam Al-Shami 2024 15 15 Measurement of Growth ▪ Additional Growth Measurements: ▪ Triceps Skinfold (TSF): reflects subcutaneous fat stores ▪ Mid Arm Circumference (MAC) ▪ Midarm Muscle Circumference (MAMC): an index of lean muscle mass ▪ Handgrip Strength: a predictor of nutrition status and a marker of muscle quality ▪ Body Mass Index (BMI): the preferred measure of adiposity. ▪ Mid-Parental Height (MPH): Average of parents’ heights in cm ± 6.5 ▪ Ideal Body Weight (IBW): 50th –ile on the weight for length ▪ Weight Age and Height Age Islam Al-Shami 2024 16 16 8  10/7/2024 DIAGNOSIS OF UNDERWEIGHT AND OVERWEIGHT ▪ Obesity: BMI ≥ 95th %-ile for age and gender ▪ Overweight: BMI 85th - 94th %-ile for age and gender Islam Al-Shami 2024 17 17 Growth Velocity ▪ The best indicator of a child’s long-term nutritional status is how fast he or she grows. ▪ Growth velocity is an especially sensitive indicator that requires periodic evaluation. ▪ Deviations from a child’s normal growth pattern should be noted, especially an increase or decrease across 2 standard deviations or measurements plotting below the 5th %-ile or above the 95th %-ile ▪ Approximately 2/3 of all children do cross growth curves in the first 2 years of life due to genetic reasons. ▪ The growth velocity of normal-term infants and children is useful in adjusting nutrition goals. Islam Al-Shami 2024 18 18 9  10/7/2024 Islam Al-Shami 2024 19 19 Islam Al-Shami 2024 20 20 10  10/7/2024 Islam Al-Shami 2024 21 21 Assessment of Malnutrition ▪ Weight is a good indicator of acute and chronic nutritional status and may be used to assess a pediatric patient’s degree of malnutrition. ▪ Weight may be classified as a percent of the standard: ▪ The Waterlow criteria to assess the degree of both acute and chronic malnutrition: Islam Al-Shami 2024 22 22 11  10/7/2024 Islam Al-Shami 2024 23 23 Medical History A complete nutritional assessment should include information on the following: ▪ Past medical history including recent hospitalizations ▪ Review of systems and history of allergies ▪ Personal and social history ▪ Presence of chronic illness such as congenital heart disease, cystic fibrosis, kidney disease, short bowel syndrome ▪ Previous growth pattern via examination of growth charts Islam Al-Shami 2024 24 24 12  10/7/2024 Medical History ▪ Recent surgeries, other deterioration in medical condition or procedures impacting nutritional intake, status, and management ▪ Medications ▪ Gestational age (for children < 3 years) ▪ Identification of low and very low birth weight infants ▪ Achievement of developmental milestones ▪ Presence of congenital abnormalities or genetic errors Islam Al-Shami 2024 25 25 Nutritional Intake History Dietary history may be obtained by the following : Twenty-four-hour recall Three-day food intake Food frequency questionnaire General interview Islam Al-Shami 2024 26 26 13  10/7/2024 Nutritional Intake History Islam Al-Shami 2024 27 27 Islam Al-Shami 2024 28 28 14