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SBH Outpatient Nutrition Services / Pediatrics

SBH Outpatient Nutrition Services / Pediatrics. Romilda Grella, MS, RD, CDN Outpatient Registered Dietitian St . Barnabas Hospital - Ambulatory Clinic 4487 Third Avenue, Bronx , NY 10457-2594 Tel: 1-718-960-5007 Pager : 1-877-714-4681  or  **807 Email:  rgrella@stbarnabas-ny.org.

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SBH Outpatient Nutrition Services / Pediatrics

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  1. SBH Outpatient Nutrition Services / Pediatrics Romilda Grella, MS, RD, CDN Outpatient Registered Dietitian St. Barnabas Hospital - Ambulatory Clinic 4487 Third Avenue, Bronx, NY 10457-2594 Tel: 1-718-960-5007 Pager: 1-877-714-4681  or  **807 Email:  rgrella@stbarnabas-ny.org

  2. The goal of nutrition management of children • support optimal growth and development • encourage physical activity and fitness • ensure the availability of adequate nutrient stores for growth demands • establish healthful eating habits that will lower the risk of chronic disease.

  3. Pediatric Patients are referred to Nutrition Services by the Pediatrician. Based on: • History of poor or inadequate intake • Weight/Height <10th %ile • Overweight >85th %ile • Obese >95th %ile • Multiple food allergies/intolerances • Known food/drug interaction • Following special diets • Have risk factor including obesity related medial conditions such as hyperlipidemia, hyperinsulinemia and high blood pressure. • Positive risk factors for type 2 diabetes, insulin resistance, cardiovascular disease risk factors. • Limited access to food • Food, nutrition related knowledge deficit • Physical inactivity • Dental carries

  4. Initial Pediatric Nutritional Assessment Subjective: • Appetite • % meals consumed • GI distress • Weight history • Medications/vitamins • Food Allergies/food intolerances • Food Preferences • Food recall (breakfast, lunch, dinner & snack)

  5. Initial Pediatric Nutritional Assessment Objective: • Diagnosis • Past Medical History • Height • Height/age %ile • Weight • Weight/age %ile • Labs • Medications • Nutrition Assessment Flowsheet

  6. Initial Pediatric Nutritional Assessment Assessment: • Assessment of nutritional risk level • Diet tolerated • Weight status • Nutritional status • Estimated caloric needs • Estimated protein needs

  7. Initial Pediatric Nutritional Assessment Plan: • Goals • Recommendations • Follow up • Referral to other services

  8. Growth Chart Boys 2-20 yrs, Weight (2000)

  9. Growth Chart Boys 2-20 yrs, Height (2000)

  10. BMI 2-20 years with 85th percentile

  11. Growth Chart Girls 2-20 yrs, Weight (2000)

  12. Growth Chart Girls 2-20 yrs, Height (2000)

  13. BMI 2-20 years with 85th percentile

  14. Adapted from http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf

  15. SBH Nutrition Services Department Standards of Care for Pediatric

  16. Calculate estimated needs appropriate for age. • Plot patient on growth chart weight for age at the 50th % • Using the weight from the 50th % (kg) multiply by the age appropriate standards of care to determine patients estimated caloric and protein needs Estimated Caloric Needs: • ____ based on ____Kcal/kg for age @ ( ___Kg 50th%ile wt for age NCHS) Estimated Protein Needs: • ____ based on ___ gm/kg/day for age @ ( ___Kg 50th%ile wt for age NCHS)

  17. Example: 15 yr F, wt: 288 lbs (130.6 kg), ht: 62 in (157 cm), BMI: 52.9 • Using the female growth chart, look up wt at 50th %ile wt for age, 15 yr. Estimated Caloric Needs: • 2132 based on 40 Kcal/kg for age @(53.3 Kg 50th%ile wt for age NCHS) Estimated Protein Needs: • 43 based on 0.8 gm/kg/day for age @(53.3 Kg 50th%ile wt for age NCHS) • Growth percentile: >97th • Wt/age %ile weight/age percentile: >97th • Ht/age %ile height/age percentile: <25th • 50th %ile, weight for age 50th percentile wt for age: 53.3 kg • 50th %ile, height for age 50th percentile wt for age: 162.2 cm • % BMI: >97th

  18. Reinforcing the Childs ability to self-manage his or her own food intake in an important component of successful life long weight management.

  19. Websites • www.choosemyplate.gov • www.fns.usda.gov • www.kidshealth.org • www.KidsEatRight.org • www.eatsmart.org • www.letsmove.org • www.nourishinteractive.com

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