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Nutrition Assessment. And Growth. Normally developing. Or Not. Goal of assessment. Why do assessment?. Level 1: Screening Done by someone else Level 2: Individual Assessment Directed at a nutritional problem Level 3: Complex Multidisciplinary interventions

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why do assessment
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
biochemistry
Biochemistry
  • Screening: when?
    • Iron
      • Does WIC eliminate the need for infant screening?
    • Lead blood lead
      • Over 10 ug/dl has intellectual consequences
      • Reference < 24 retest in one year
      • OK has problems with environmental contamination
        • Mining
        • Oil and gas production
        • Houses before 1980’s
biochemistry1
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!
clinical
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
behaviors
Behaviors
  • Food related behaviors
    • Aversions
    • Allergies
    • “Manipulations”
      • Pizza
      • Chocolate milk
    • Family patterns
  • Who is responsible for providing a good diet?
feeding skills
Feeding skills
  • Oral motor: Can they safely swallow?
    • Speech problems
    • Gagging and choking
    • Frequent coughing, asthma
  • Gross motor
    • Control to mouth
  • Fine motor
    • utensils
sensory integration
Sensory integration
  • Normal taste development
    • Prop tasting
  • Medically induced aversion
  • Neurological dysfunction
    • Over sensitive
    • Under sensitive
  • Interpersonal interaction?
dietary intake
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?
dietary assessment
Dietary Assessment
  • Supplements
    • Especially with kids with disabilities
  • Medications
    • ADHD
  • Age appropriate norms
    • Fat content
  • Unusual food habits
energy needs ree
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
energy needs ree adjustments
Energy needs: REE adjustments
  • Activity factor ? around 2
  • Illness
    • IBD, Cystic Fibrosis, Spastic Quad, Congenital heart defects, Biliary Artesia
  • Growth
    • Need extra calories
anthropometry
Anthropometry
  • BEST and most sensitive
    • First weight, then height
  • Growth is not

Synchronous

Continuous

  • Accurate timely measurements
  • Multiple methods
beyond growth charts
Beyond growth charts
  • Ideal growth chart is only healthy kids
  • In Atlanta study, children < 3rd percentile
    • 85% inpatients had disease or low birth weight
    • 55% outpatients had disease or low birth weight
      • Sherry et al, Nutrition Research 2000 20:1689-1696.
  • Velocity: charts from Ross
  • Stage of development
    • Early vs. late
beyond growth charts1
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
    • Down’s, Prader-Willi, Spinal bifida, Turner’s, Duchenne’s muscular dystrophy
reference
Reference
  • Samour PQ, Helm KK, Lang CE. Handbook of Pediatric Nutrition. Aspen Publication