Nutrition Assessment

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Nutrition Assessment

• And Growth

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Goal of assessment

• Normally developing

• Or Not

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Why do assessment?

• Level 1 Screening
• Done by someone else
• Level 2 Individual Assessment
• Directed at a nutritional problem
• Level 3 Complex Multidisciplinary interventions
• To develop a coordinated interdisciplinary plan

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Biochemistry

• Screening when?
• Iron
• Does WIC eliminate the need for infant screening?
• Lead blood lead
• Over 10 ug/dl has intellectual consequences
• Reference lt 24 retest in one year
• OK has problems with environmental contamination
• Mining
• Oil and gas production
• Houses before 1980s

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Biochemistry

• Age adjusted norms
• BUN 1-3 5-17mg/dl
• 4-13 7-17
• 14-19 8-21
• Low 6-8 indicates over-hydration in
  adults not kids!
• Check with your lab!

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Clinical

• Non specific
• You need to look for them!
• General appearance
• Hair skin nails
• Flag sign
• Spoon nails
• Oral area
• Poop!
• Heart rate change slow malnutrition, fast anemia

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Behaviors

• Food related behaviors
• Aversions
• Allergies
• Manipulations
• Pizza
• Chocolate milk
• Family patterns
• Who is responsible for providing a good diet?

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Feeding skills

• Oral motor Can they safely swallow?
• Speech problems
• Gagging and choking
• Frequent coughing, asthma
• Gross motor
• Control to mouth
• Fine motor
• utensils

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Sensory integration

• Normal taste development
• Prop tasting
• Medically induced aversion
• Neurological dysfunction
• Over sensitive
• Under sensitive
• Interpersonal interaction?

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Dietary intake

• Where does the child eat?
• Who is responsible for meal planning?
• Who is the best reporter?
• Cognitive problems
• Variable intake
• 3 days?
• Palm pilots?

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Dietary Assessment

• Supplements
• Especially with kids with disabilities
• Medications
• ADHD
• Age appropriate norms
• Fat content
• Unusual food habits

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Energy needs REE

• WHO equations W wt in kg
• Male
• 0 - 3 yr 60.9 W 54
• 3 -10 22.7 W 495
• 10 - 18 17.5 W 651
• Female
• 0 - 3 61 W -51
• 3 - 10 22.5 W 499
• 10 18 12.2 W 746

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Energy needs REE adjustments

• Activity factor ? around 2
• Illness
• IBD, Cystic Fibrosis, Spastic Quad, Congenital
  heart defects, Biliary Artesia
• Growth
• Need extra calories

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Anthropometry

• BEST and most sensitive
• First weight, then height
• Growth is not
• Synchronous
• Continuous
• Accurate timely measurements
• Multiple methods

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Beyond growth charts

• Ideal growth chart is only healthy kids
• In Atlanta study, children lt 3rd percentile
• 85 inpatients had disease or low birth weight
• 55 outpatients had disease or low birth weight
• Sherry et al, Nutrition Research 2000
  201689-1696.
• Velocity charts from Ross
• Stage of development
• Early vs. late

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Beyond growth charts

• Fat mass
• Triceps not sub-scapula
• Parent adjustment
• Tanner Fetus into man (1978)
• Body composition Child equations
• Disease specific charts
• evaluate carefully, sample size, exclusion
  criteria
• Downs, Prader-Willi, Spinal bifida, Turners,
  Duchennes muscular dystrophy

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Reference

• Samour PQ, Helm KK, Lang CE. Handbook of
  Pediatric Nutrition. Aspen Publication