MALNUTRITION

TUTORIAL

PEDIATRIC NUTRITION CARE

PROCESS

1)
2)
3)
4)
5)

Assessment
Requirement
Route
Dietary Regimen/Formula
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

slowly

with higher than ideal target then reduce

Recommended Daily
Allowance
Age
(year)
0-1
1-3
4-6
7-9
10-12
12-18

Energy (kcal/kg body

weight/day)
110-120
100
90
80
Male: 60-70
Female: 50-60
Male: 50-60
Female: 40-50

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 requirement
6,5 Kg x 80 100 = 520 650 Kcal
Formula 75 : 100 mL = 75 Kcal
Volume 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

THANK YOU