Pediatric Assessment

Assessment of infant and children

- Anthropometric :

Wt / Age :

Wt / Age < 5th % indicate acute state of malnutrition ( wasting ) .

Acute nutritional status = Actual wt x100

50th percentile wt/ht

chronic nutritional status= Actual Ht x 100

50th percentile Ht/age

Recent wt change may indicate acute nutrition issues . In children , the following looses are consider significant :

% wt change = [ (actual wt –usual wt) /usual wt] x100

% usual body wt = (actual wt /usual wt ) x100% Ideal body wt (IBW) = actual wt x100 IBW at 50th percentile for

age

1 week 1month 3month 6month

2% 5% 7.5% 10%

• Ht /Age :Ht / Age <5th % indicate chronic state of

malnutrition (stunting) .

• Wt /HtThe wt of child at specific stature regardless

of age.

• BMI :For children of age 2-20 BMI =WT /HT2 X10000

• Head circumference ( birth – 3

years ) :Less sensitive indicator for nutritional status.

-Biochemical:Albumin, Hemoglobin, cholesterol, TG, Serum glucose.

Cholesterol:

Children how should be tested at age 2 years or older :

- At least on parent how has been found to have high blood cholesterol > 240 mg / dl or greater .- A family history of early heart disease < 55 years in a parent or grandparent .

-Clinical :

APGAR score diagnosis or history of chronic or acute condition :

A Activity

P Pulse

G Response to stimuli

A Appearance

R Respiratory statues immediately at the time of birth .

Nutrient need:

Energy and protein:

Fat : 30-54 % of kcal

CHO: 30 – 60% of kcal < 10% of total kcal can lead to ketosis .

Water : Fluid req:

1st 10 kg 100ml /kg11-20 kg 1000ml +50 ml /kg (for each kg above . 10) >20 kg 1500 ml + 20 ml /kg (for each kg . above 20)

Vitamin and minerals:.

Definition: Weigh loss or lack of weight gain in a

child due to chronic illness, a restricted diet, poor appetite , and some socio-environmental issues.

• Defined as height or weight less than the third to fifth percentiles

Failure to thrife

Classification:

• Non-organic FTT :

- Results from various environmental and psychosocial factors.

- Associated with abnormal interactions between the caregiver and the infant or child. This can result in an inadequate provision of food or inadequate intake of food.

- Occurs usually in younger than 2 years old .

• Organic FTT :

- occurs when there is an underlying medical cause.

Assessment: • History:

Prenatal history : Smoking Alcohol consumption Use of medications Any illness during the pregnancy

Dietary history : Determine whether a child is receiving enough

energy intake.

How formula is prepared: - Improperly prepared formula can result

in FTT and serious electrolyte imbalances.

Solid foods intake: - a careful history of the type of food,

meal frequency, and volume per feeding.

- If history is difficult to obtain, a food diary of up to 3 days may be requested from the parents.

Current medical condition: - Infections ,chronic conditions, such as cerebral

palsy (CP), , seizures ..

Physical: - Head circumference, height, and weight - Vital signs. - Physical examination may show the following:

• - Edema • - Wasting • - Rash or skin changes • - Hair color and texture changes • - Mental status changes • - Signs of vitamin deficiency

Diet Management : Goal: - to provide adequate energy intake for catch-up growth.

• Adjust/concentrate infant formula to meet specific nutrient needs:

eg : - Increase up to 30 kcal/oz.

- 20 kcal/oz formulas + high-calorie food fortifiers, which can be lipids, protein, or carbohydrates.

• Supplements for older children may include adding cheese, sour cream, butter, margarine, or peanut butter to meals. Also, high-energy shakes

• ( Pedia Sure, Boost).

• Multivitamin and mineral supplements, including iron and zinc, usually are recommended .

• Tube feeding indicated for cases of severe malnutrition.

• continuous nighttime tube feeding may be used to increase their energy intake :

- In younger children, using 24 or 27 kcal/oz, or adding calorie fortifiers.

- In toddlers, 30 kcal/oz

Case study

• Sara is 3.5 years old Saudi female , her vital sign is normal .

• Wt =9 kg , Ht = 92 cm • diet Rx : DFA. Wt /age is < 5th % Ht/age is on 10th %

Wt/ht is < 5th % IWt/age =15 kg IHt/age =97 cm % Wt /age =(9 /15) x100 =60 %BMI = [9/(0.92) X (0.92) ] = 10.6 kg/m BMI /Age <5TH %

• Acute malnutritional status = (9/13.4) x100 =67.16 % stage 3 (severe acute malnutrition).

• Chronic malnutrition status= (92/97) x100= 94.8% stage 0 (mild chronic malnutrition)

• Pt need catch up growth.

• Energy = 98 x15 /9 =163 x9 = 1470 kcal /day

• Protein = 1.6 x15 /9 = 24 gm /day

Nutritional requirment:

• Energy 163 kcal /kg =1470 kcal /day

• Protein 2.7 gm / kg =24 gm /day

• Protein 6.5 % = 24 gm• Cho 53.5 % =197 gm• Fat 40 % = 65 gm

Thank you