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Nutritional Assessment- Failure to Thrive Eileen Cress, MS, RD, LDN August 9, 2012 PowerPoint Presentation
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Nutritional Assessment- Failure to Thrive Eileen Cress, MS, RD, LDN August 9, 2012. Failure to Thrive. Inadequate physical growth or the inability to maintain the expected rate of growth over time. Undernutrition. Early Detection. First checkups key to early detection

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slide1

Nutritional

Assessment-

Failure to Thrive

Eileen Cress, MS, RD, LDN

August 9, 2012

failure to thrive

Failure to Thrive

Inadequate physical growth or the inability to maintain the expected rate of growth over time.

Undernutrition

early detection
Early Detection

First checkups key to early detection

Calculate weight gain and compare to minimum recommended infant gain of 15 to 30 g per day after 2 weeks of age, allowing for regain of birth weight (1)

etiology
Etiology
  • Mixed etiology is common
  • Functional vs organic
  • More often result of psychosocial problems.
  • Gahagan and Holmes 1998: Spend more time on history than other investigative studies first. (1)
nutritional assessment
Nutritional Assessment
  • Anthopometrics- weight, height, head cm
  • Medical History including weight change
  • Physical Exam
  • Medication and labs
  • Diet evaluation: meal environment, patterns, intake, food availability
  • Feeding behavior and feeding skill development
  • Caregiver knowledge/myths/behaviors
nutritional assessment1
Nutritional Assessment
  • Financial resources
  • Food intolerances or allergies
  • Cultural, religious, or ethnic preferences
  • Family viewpoint regarding nutrition and feeding
  • Estimate nutrient needs
  • Evaluate adequacy of nutrition regimen
nutritional assessment2
NutritionalAssessment

Evaluate Meal Environment

Time spent

Mood

Seated at a highchair or table?

Infants properly held?

nutritionalassessment
NutritionalAssessment

Evaluate Meal Patterns/Intake-infants

Infant feeding- amount of breastmilkor formula, other ( juice, water, cereal)

Formula preparation

Presence of reflux /vomiting/diarrhea

Frequency of feedings

nutritionalassessment1
NutritionalAssessment

Evaluate Meal Patterns / Intake

Infant Feeding Guidelines:

Birth–1 month: 2-4 oz, 6 or more times/d

1-3 months: 4-6 oz, 5-7 times/d

3-6 months: 6-7 oz, 4-6 times/d

6-9 months: 6-8 oz, 4-6 times/d

10-12 months: 7-8oz, 3 times /d

nutritionalassessment2
NutritionalAssessment

Feeding behavior and feeding skill development-infants

Transition to solids 4-6 months

Transition to diced and finger foods 9-12 months, including all food groups

Use of cup 10-12 months

Eliminate bottle at 12 months

nutritionalassessment3
NutritionalAssessment

Evaluate Meal Patterns/Intake-toddlers

Toddlers- grazing, portions of food items, frequency of meals/snacks.

Food Intake Diary- 3-day including one weekend day

nutritional assessment3
Nutritional Assessment

Common Problems

Formula over- dilution

Large amount of baby cereal in bottle

Excess juice or other beverage

No feeding schedule

No high chairs/ Infants not held to bottle feed

Multi caregivers

Distractions

nutritional assessment4
Nutritional Assessment

Estimating nutrient needs

Energy and protein needs determined by using Dietary Reference Intakes of the Food and Nutrition Board, National Academy of Sciences.

nutritional assessment5
Nutritional Assessment

Catch up growth

Calories

Kcal/kg age x IBW for ht (kg) = kcal/kg actual wt

actual wt/kg

Protein

Gm/kg for age x IBW for ht (kg) = gm/kg actual wt

actual wt (kg)

nutritional assessment6
Nutritional Assessment

Possible Interventions:

Caregiver Education

Develop feeding schedule

Concentrated formulas

Supplemental formulas

Food additives to puree foods

nutritional assessment7
Nutritional Assessment

Food Additives to Enhance Calories (4)

suggested websites
Suggested Websites

http://abbottnutrition.com(Abbott Nutrition/ Similac products)

http://www.gerber.com( Gerber/Nestle Good Start products)

http://www.mjn.com(Mead Johnson/Enfamil products)

http://eatright.org

http://www.mypyramid.gov

http://www.heinzbaby.com

http://www.healthychildren.org

http://www.keepkidshealthy.com

references
References

1. Gahagan S., Holmes R. A Stepwise Approach to Evaluation of Undernutrition and Failure to Thrive.

PediatrClin North Am. 1998 Feb; 45(1): 169-87.

2. A.S.P.E.N. Board of Directors. Nutrition Assessment: Pediatrics . J Parenter Enteral NutrJanuary 2002 26:

no.1SA.

3. Mascarenhas, M R., Zemwl, B, Stallings, V.A. Nutritional Assessment in Pediatrics. Nutrition 1998. 14(1):105-

115.

4.Samour, P.Q., King, K. Pediatric Nutrition. 2012, 4th ed. Jones and Bartlett., Sudbury, MA..