Pediatric Nutritional Assessment and Growth Monitoring DR.

Ramolete February 13, 2014

Key Elements o >90th percentile: overweight

 Medical history
 Dietary history 2) Weight for length/height
 Physical examination and anthropometric measurements
 Biochemical and metabolic changes 3) Length/height
 Linear measurements can’t decrease
I. Medical History  Reflects chronic underweight when determined serially
1. Primary
A. Inadequate food intake Anthropometric measurements:
B. Low socio-economic status  Weighing scale
2. Secondary  Board for length or height
A. Inadequate food with concomitant disease  Growth curve (NCHS)
 Z score graph
II. Dietary Assessment  Weight
1. Qualitative Method  Height
A. Evaluates the pattern, style, and type of food  Mid-arm circumference
B. Four basic food groups  Skinfold thickness
C. Dietary prescriptions  Head circumference

2. Quantitative method Anthropometric measurements:

 Calculate precise energy and nutrient intake  Length
o Two ways of evaluation of food intake o Recumbent position up to 3 years old to offset the lordotic posture
 24 hour recall type at that age
*if based on holiday NOT IDEAL o Height: 3 years old
*for ORDINARY DAY RECALL o Note:
 3day food recall  On the 1st 3 years
*summarizes basic things a child takes in  Genetic has no role during early years in life
 Environmental factors
III. Physical Examination
 Nutrition
1. Wasting
 Height velocity (rate of growth)
2. Edema
o Best growth indication of child’s long term nutritional status
3. Lethargy
o Done serially for at least 4-6 months
4. Muscle weakness
o Growth increment is important
5. Fat stores
 How fast does he/she grow?
6. Signs of micronutrient deficiency
 Birth to 6 months:14 cms increase
 Pallor
 Two years: 9cms/year
 Hair color
 Ten years: 5cms/year
 Plot in growth chart
VADAG Program
1. Vitamin A deficiency
Criteria for Growth Retardation
 Nyctalopia, photophobia 1. Persistent deceleration from the established growth pattern
 Conjunctivalxerosis, Bitot’s spots 2. Height and weight persistently below the p5 on standard growth chart
 Corneal xerosis, keratomalacia 3. Height velocity of 5 cm or less/year
 Blindness IV. Biochemical Changes
2. Anemia  Reflects early deficiency even without obvious overt signs of
 Criteria: HGB of 11 gm, HCT of 36 malnutrition
 Iron deficiency: most common  Serum protein albumin
 Copper and folic acid deficiency  Hemoglobin
3. Goiter  Transferrin
 *iodized salt  Serum iron
 Lymphocyte count
Anthropometric Measurements  Proteins
 Weighing scale  Vitamin assays
 Board of length or height
 Growth curve (NCHS) Treatment:
 Weight 1. Phase I: treat complications
 Height 2. Phase II: continue feeding
 Mid-arm circumference 3. Phase III: rehabibiliation
 Skinfold thickness
 Head circumference

Anthropometric Measurements
1) Weight
 Growth parameter
 Age and sex reference
 Weight for age
o 10th percentile and above: normal
o <10th percentile: underweight

Medical Nutrition Finals Page 1

Pediatric Nutritional Assessment and Growth Monitoring DR. Ramolete February 13, 2014

TIME FRAME FOR THE MANAGEMENT OF A CHILD WITH SEVERE Sodium 0.6 mmol 1.9 mmol
MALNUTRITION
ACTIVITY INITIAL REHABILITATION FOLLOW- Magnesium 0.43 mmol 0.73 mmol
TREATMENT UP
Zinc 2.0 mg 2.3 mg
Day Day Week 2-6 Week 7-8
1-2 3-7 Copper 0.25 mg 0.25 mg

Hypoglycemia % from fats 32% 53%

Hypothermia % from proteins 5% 12%

Dehydration Osmolarity 333 mosmol/L 419 mosmol/L

Correct
electrolyte
LABORATORY FEATURES OF SEVERE MALNUTRITION
imbalance
Hgb, hct, erythrocyte count, Degree of dehydration, anemia, and
Treat infection mean corpuscular volume type of anemia

Correct W/o iron With iron Glucose Hypoglycemia

micronutrient
deficiencies Electrolyte and alkalinity Hyponatremia, type of dehydration

Begin feeding Sodium

Potassium Hypokalemia (in marasmus*)

Catch up Chloride, pH, bicarbonate Metabolic alkalosis or acidosis

growth
Total protein, transferrin Degree of protein deficiency
Ultimate
Creatinine Renal function
emotional and
sensorial dev’t CRP Presence of bacterial, viral infections or
malaria
***Know the 2 graphs by heart- Dr. Ramolete
Stool exam Presence of parasites
***PREPARATION OF F75 AND F100 DIETS
Ingredient F75 DIET F100 DIET
ELEMENTS IN THE MANAGEMENT OF SEVERE PROTEIN ENERGY MALNUTRITION
Dried skim milk 25 grams 80 grams  Hypothermia
o Warm patient, maintain and monitor body temperature
Sugar 70 grams 50 grams
 Hypoglycemia
o Monitor blood glucose, provide oral or IV glucose
Cereal flour 35 grams --
 Dehydration
o Rehydrate carefully with solution of led sodium and more potassium than
Vegetable oil 27 grams 60 grams
standard mix
Mineral mix 20 ml 20 ml  Micronutrients
o Provide iron, zinc, copper, folate, multivitamins
Vitamin mix 140 mg 140 mg  Infection
o Administer antibiotics, anti-malaria, even in the absence of typical symptoms
Water to make 1000ml 1000 ml  Electrolyte
o Supply plenty of potassium and magnesium
 Starter nutrition
***COMPOSITION OF F75 AND F100 DIETS o Keep protein and volume overload low
COMPOSITION F75 DIET F100 DIET (AMT IN 100  Tissue building nutrition
ML) o Provide a rich diet, dense in energy and proteins
(AMT IN 100 ML)  Stimulation
o psychosocial stimulation
Energy 75 kcal 100 kcal (420KJ)  Prevention of relapse
o monitor and follow up
(315 KJ)

Protein 0.9 grams 2.9 grams

Lactose 1.3 grams 4.2 grams

Potassium 3.6 mmol 5.9 mmol

Medical Nutrition Finals Page 2