MALNUTRITION TUTORIAL

PEDIATRIC NUTRITION CARE PROCESS

1) Assessment 2) Requirement 3) Route 4) Dietary Regimen/Formula 5) Evaluation

Assessment

Clinical sign/problems Anthropometry Laboratory Dietary analysis

ANTHROPOMETRY

Ideal Body weight (%) Z score BMI

Growth Curves WHO 2005 CDC 2000

Classification Waterlow

Ideal body weight

90-110 % Normal

70-90% Mild to moderate mal nutrition

< 70% Severe malnutrition

110-120% Overweight

>120% Obese

BMI for age

P 85- 95 Overweight

P > 95 Obese

Classification WHO

Case 1

A baby girl 9 months years old came for immunization. Bodyweight 6,8 Kg, body height 70 cm.

Define her nutritional status based on: Z score with WHO 2005 charts

Nutritional Status

Answer case 1

Mild to moderate mild nutrition

WHO 2005 Z score between -2SD and - 3SD Ideal bodyweight 8,2 kg

WHO Anthro

Requirement

Calorie = Ideal bodyweight x RDA Severe malnutrition

must not be given directly the target calorie begins with lower calorie and adjust slowly

Obese Begin with higher than ideal target then reduce

slowly

Age (year)

Energy (kcal/kg body weight/day)

0-1 110-120

1-3 100

4-6 90

7-9 80

10-12 Male: 60-70Female: 50-60

12-18 Male: 50-60Female: 40-50

Recommended Daily Allowance

Case 2

Define calorie needed by case 1

Height age : Ideal bodyweight x RDA 8,2 x 110 = 902 kcal

900 kcal

Height age

Case 3

Boy, 15 months old with bodyweight 6,5 Kg, body length 75 cm admitted to hospital because of recurrent diarrhea. He looked very thin and physical examination revealed baggy pants appearance.

Defined diagnosis and initial treatment

Nutritional Status

Diagnosis

Clinical signs : baggy pants, very thin

IBW = 6,5 : 9,5 = 68% Z score = < - 3 SD Severe malnutrition

Requirement

Height age = 1 year Ideal Caloric Requirement :

9,5 x 110 = 1045 ≈ 1000 kcal

Management

…Management

Find and treat emergencies Hypothermia Hypoglycemia Dehydration Electrolyte imbalance

Find and treat underlying diseases Infection

…Management

Nutritional treatment Stabilization phase

Formula 75 Energy 80-100 Kcal/kgBW Fluid 130 mL/kgBW/day

Transition and rehabilitation phase Formula 100

…Management

Fluid requirement 6,5 x 130 mL = 845 mL

Energy requirement6,5 Kg x 80 – 100 = 520 – 650 Kcal

Formula 75 : 100 mL = 75 KcalVolume F 75 = (520:0,75) – (650:0,75)

= 693 – 866 mL

…Management

Frequency : every 2-3 hours Tolerance

8 x 100 mL

Transitional and Rehabilitation Phase Increase volume or concentration

…Management

Micronutrient Mineral mix Vitamin A Folic Acid Iron supplementation

Vitamin A 200.000 IU Folic Acid 5 mg at first day then 1 mg/day

Case 4

Lola, a 4,5 -year old girl with body weight 23 Kg, body height 104 cm.

Define the nutritional status Define the calorie needed State the principles of treatment

Answer

Ideal body weight (%) 23/16 = 143% BMI = 23/(1.04)2 = 21.2

BMI CDC 2000 : > p95 Obese

23/16.4 = 140% WHO > 3 SD Obese

Requirement 16 kg x 100 kcal/kg = 1600 kcal

Dietary advice Regular meal time and snack Fruit and vegetables consumption Plain water Calorie?? Reduce 300-500 kcal than usual diet

Principles of management

Dietary management Physical activity Behavior modification

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