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Nutrition Assessment

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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Nutrition Assessment

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  1. Nutrition Assessment And Growth

  2. Normally developing Or Not Goal of assessment

  3. 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

  4. 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

  5. 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!

  6. 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

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

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

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

  10. 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?

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

  12. 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

  13. Energy needs: REE adjustments • Activity factor ? around 2 • Illness • IBD, Cystic Fibrosis, Spastic Quad, Congenital heart defects, Biliary Artesia • Growth • Need extra calories

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

  15. 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

  16. 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

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

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