Nutritional Assessment –The Right Perspective

1. Nutritional Assessment –The Right Perspective -Dr ShrishBhatnagar

2. Dr. ShrishBhatnagar Consultant Paediatric Gastroenterologist , Eras Lucknow Medical College and Hospital, Lucknow.Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow.

3. Growth Monitoring • Growth Monitoring is a screening tool to diagnose nutritional, chronic systemic and endocrine disease at an early stage. • It has been suggested that growth monitoring has the potential for significant impact on mortality even in the absence of nutrition supplementation or education

4. Aims and Rationale Primary aim: • To identify children with growth deviation i.e., under nutrition and over nutrition and to identify diseases and conditions that manifest through abnormal growth. Secondary aims: 1. To discuss health promotion related to feeding, hygiene, immunization and other aspects of the child’s health and behaviour; education of parents to allay their anxiety about their child’s growth. 2. To sensitize paediatricians to use growth charts

5. - Who ?

6. How often to monitor ? • At Birth – Wt, length, HC , Penile length, testicular decent • At every immunization contact till 18 months • 18 months – 9yrs – every 6 months weight/ height • > 9yr – yearly Weight &height • > 5 yrs – BMI , PL , SMR Yearly IAP 2014 Wt= Weight;; HC= Head Circumference BMI= Body mass Index; SPL= Penile Length; SMR= Sexual Maturity Rate

8. Rigid Board on a hard surface may also be used

11. Correction for MPH Male 9 years • Height 119 cms and weight 20 kg • Father is 157 cms, mother is 150 cms, • Formula for target height (MH+FH+/-6.5) • Target Height is 160 (154-166)

12. Longitudinal WHO

14. WHO

15. Body Mass Index Observe Refer

17. > 85th Over weight & Obesity 5th – 85th Normal <5 percentile Malnutrition

20. Mid parental height

21. 10 yr /F Ht 127 cm Wt = 25 11 yr /F Ht 131 cm Wt= 26 Familial Short Stature

22. Malabsorption Celiac Disease

23. Endocrinal

26. Growth Chart Interpretation Wt age < Ht age < Age Nutritional Short Stature • Cushings ; Hypothyroid • PraderWilli • Drugs • Malnutrition • Chronic Infections • MAS like Celiac Ht age < Wt age < Age Endocrinal • Hypothyroid • G.H. Deficiency • RTA • Syndromes --Turner Ht age < Age < Wt age  Endocrinal Obesity Age < Ht age < Wt age  Nutritional

27. Quiz

28. Q1 • How many person are required to measure infant length using a infantometer? • One person • Two person • Three person

29. Q2 • What instrument is used to measure height in children > 2yrs? 1. Stadiometer 2. Infantometer 3. Measuring tape and scale

30. Q3 • When to refer less <2 yrs based on the findings of the growth chart ? All of the statements are true about except • Child < 3rd centile for height/ length or weight • If weight < -3 SD (on weight for length chart) • Crossing two major centile • Lack of weight gain for a month in the first 6 months • Lack of weight gain for 2-3 months from 6-12 months

33. Q4 • When to refer less > 2 yrs based on the findings of the growth chart ? All of the statements are true about except • Child < 3rd centile for height or weight for IAP growth charts • Crossing two major centile • Child above and below for MPR for height • When BMI > 23 adult equivalent start watching, when crosses > 27 adult equivalent refer • Lack of growth of 10 cm/ year • Signs of puberty before 8 yr for girls and 9 yr for boys

34. Q5 • What is the ideal growth chart of preterm babies ? • Fenton • CDC • WHO charts • Bailey charts

35. Thank You