NUTRITIONAL ASSESSMENT

NUTRITIONAL ASSESSMENT
Nutritional assessment can be defined as:
An evaluation of the nutritional status of individuals through measurements of food and nutrition intake and evaluation of nutrition-related health indicators.

What should we consider about nutritional Assessment?

General information ( age, gender, education, occupation, environment, medical history, etc)
Instruments Criteria of nutritional status

Nutritional Assessment

D= direct method Biochemical assessment Anthropometric assessment Clinical assessment Body composition assessment

Nutritional Assessment

I= indirect assessment

Dietary survey
Vital statistic Morbidity and cause-specific mortality rate Environment

Anthropometry Assessment
Wt, (Wt/age) Length Ht (Ht/age) Wt/ht BMI (Body Mass Index)

INITIAL PREPARATION
Ensure that the mother/caregiver understands what is happening.

Measurement of weight and length can be traumatic; participants need to be comfortable with the process.
Keep equipment normal temperature, clean and safely secured. Work out of direct sunlight since it can interfere with reading scales and other equipment and is more comfortable for people.
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When to Weigh and Measure

Weigh and measure the child only after collecting all verbal information. This will allow you to become familiar with the members and help the mother and child feel more comfortable before the measurements begin.
Weigh and Measure One Child at a Time:

Complete any questions and measurements for children one at a time. Do not weigh and measure all the children together. This can easily cause confusion and will create a greater for errors such as recording one childs measurements on another child's form.

When to Weigh and Measure

Control the Child: When weighing and measuring children, keep them as calm as possible. A child who is excited or scared can make it difficult to get an accurate measurement. Be firm yet gentle with children. Your own sense of calm and self confidence will be felt by the mother and child.

Recording Measurements:

Record all measurements in pencil so that if a mistake is made, it can be corrected

Instructions for Weighing a Child.

Using a Salter Hanging Scale
1. Measurer or Assistant: Hang the scale from a secure place like the ceiling beam. You may need a piece of rope to hang the scale at eye level. Ask the mother to undress the child as much as possible. 2. Measurer: Attach a pair of the empty weighing pants to the hook of the scale and adjust the scale to zero, then remove from the scale. 3. Measurer: Have the mother hold the child. Put your hands through the leg holes of the pants. Grasp the childs feet and pull the legs through the leg holes. Make certain the strap of the pants is in front of the child

Instructions for Weighing a Child..

4. Measurer: Attach the strap of the pants to the hook of the scale.

DO NOT CARRY THECHILD BY THE STRAP ONLY.

Gently lower the child and allow the child to hang freely 5. Assistant: Stand behind and to one side of the measurer ready to record the measurement. Have the form ready. 6. Measurer and Assistant:

Check the child's position. Make sure the child is hanging freely and not touching anything. Repeat any steps as necessary.

Instructions for Weighing a Child..

7. Measurer: Hold the scale steady and read the weight to the nearest 0.1 kg. Call out the measurement when the child is still and the scale needle is stationary. Even children who are very active, which causes the needle to wobble greatly will become still long enough to take a reading. WAIT FOR THE NEEDLE TO STOP MOVING.

8.

Assistant: Immediately record the measurement and show it to the measurer.

Instructions for Weighing a Child..

9. Measurer: As the assistant records the measurement, gently lift the child by the body. DO NOT LIFT THE CHILD BY THE STRAP OF THE WEIGHING PANTS. Release the strap from the hook of the scale.

10. Measurer: Check the recorded measurement on the form for accuracy and legibility. Instruct the assistant to erase and correct any errors

Instructions for Measuring Height for Children 24 Months and Older

Two Trained People Required: When possible, two trained people should measure a childs height and length. The measurer holds the child and takes the measurements. The assistant helps hold the child and records measurements. If there is only an untrained assistant such as the mother, the trained measurer should also record the measurements.

Instructions for Measuring Height for Children 24 Months and Older

1. Measurer or assistant: Place the measuring board on a hard flat surface against a wall, table, tree, staircase, etc.

Make sure the board cannot move.

2. Measurer or assistant: Ask the mother to remove the childs shoes and unbraid any hair that would interfere with the height measurement. Ask her to walk the child to the board and to kneel in front of the child. 3. Assistant: Place the form and pencil on the ground (Arrow 1). Kneel with both knees on the right side of the child (Arrow 2).

Instructions for Measuring Height for Children 24 Months and Older

4. Measurer: Kneel on your right knee on the childs left side (Arrow 3). This will give you maximum mobility. 5. Assistant: Place the childs feet flat and together in the center of and against the back and base of the board. Place your right hand just above the childs ankles on the shins (Arrow 4), your left hand on the childs knees (Arrow 5) and push against the board. Make sure the childs legs are straight and the heels and calves are against the board (Arrows 6 and 7). Tell the measurer when you have completed positioning the feet and legs. 6. Measurer: Tell the child to look straight ahead at the mother who should be already kneeling in front of the child. Make sure the childs line of sight is level with the ground (Arrow 8). Place your open left hand under the childs chin. Gradually close your hand (Arrow 9).

Instructions for Measuring Height for Children 24 Months and Older

Do not cover the childs mouth or ears. Make sure the shoulders are level (Arrow 10), The hands are at the childs side (Arrow 11), and the head, shoulder blades and buttocks are against the board (Arrows 12, 13, and 14). With your right hand, lower the headpiece on top of the childs head. Make sure you push through the childs hair (Arrow 15). 7. Measurer and assistant: Check the childs position (Arrows 1-15). Repeat any steps as necessary. at the childs side, and the head, shoulder

Instructions for Measuring Height for Children 24 Months and Older

8. Measurer: When the childs position is correct, read and call out the measurement to the nearest 0.1 cm. Remove the headpiece from the childs head and your left hand from the childs chin. 9. Assistant: Immediately record the measurement and show it to the measurer. 10. Measurer: Check the recorded measurement on the form for accuracy and legibility. Instruct the assistant to erase and correct any errors.

Instructions for Measuring Length for Infants and Children 0 23 Months

1. Measurer or Assistant: Place the measuring board on a hard flat surface, i.e., ground, floor, or steady table. 2. Assistant: Place the form and pencil on the ground, floor, or table (Arrow 1). Kneel with both knees behind the base of the board if it is on the ground or floor (Arrow 2). 3. Measurer: Kneel on the right side of the child so that you can hold the foot piece with your right hand (Arrow 3).

4. Measurer and Assistant: With the mothers help, lay the child on the board by supporting the back of the childs head with one hand and the trunk of the body with the other hand.
Gradually lower the child onto the board. 5. Measurer or assistant: Ask the mother to kneel close on the opposite side of the board facing the measurer as this will help to keep the child calm.

Instructions for Measuring Length for Infants and Children 0 23 Months

6. Assistant: Cup your hands over the childs ears (Arrow 4). With your arms comfortably straight (Arrow 5), place the childs head against the base of the board so that the child is looking straight up. The childs line of sight should be perpendicular to the ground (Arrow 6). Your head should be straight over the childs head. Look directly into the childs eyes. 7. Measurer: Make sure the child is lying flat and in the center of the board (Arrows 7). Place your left hand on the childs shins (above the ankles) or on the knees (Arrow 8). Press them firmly against the board. With your right hand, place the foot piece firmly against the childs heels Arrow 9).

Instructions for Measuring Length for Infants and Children 0 23 Months

Instructions for Measuring Length for Infants and Children 0 23 Months

Instructions for Measuring Length for Infants and Children 0 23 Months

8. Measurer and assistant: Check the childs position Repeat any steps as necessary.

9. Measurer: When the childs position is correct, read and call out the measurement to the nearest 0.1 cm. Remove the foot piece and release your left hand from the childs shins or knees.
10. Assistant: Immediately release the childs head, record the measurement, and show it to the measurer. 11. Measurer: Check the recorded measurement on the form for accuracy and legibility. Instruct the assistant to erase and correct any errors.

Clinical Assessment
The medical history and physical examination are clinical methods used to detect signs and symptoms of malnutrition.

Edema is one the of important sign that must not be ignored because it common saying that; Bipedal edema under the age of five should be considered nutritional until prove otherwise Signs are observations made by a qualified examiner during examination.

Clinical Assessment
Night blindness : vitamin A deficiency Tetany : calcium deficiency Painful cracks in the angles of the mouth: riboflavin or niacin deficiency Thyroid gland enlargement : iodine deficiency

Mid Upper Arm Circumference (MUAC)

Arm circumference is measured on the upper left arm. To locate the correct point for measurement, the childs elbow is flexed to 90 degree, with the palm facing upwards.

A measuring tape is used to find the midpoint between the end of the shoulder (Acromion) and the tip of the elbow (Olecranon); this point should be marked. The arm is then
Allowed to hang freely, palm towards the thigh, and the measuring tape is placed snugly around the arm at the midpoint mark. The tape should not be pulled too tight.

Location of midpoint of the upper arm.

Biochemical or Laboratory Assessment

measured a nutrient or its metabolite in blood, urine, feces or measuring a variety of other components in blood and other issue that have relationship to nutritional status. biochemical techniques e.g: hemoglobin, albumin, cholesterol, plasma retinol, serum zinc, urinary iodine etc.

How to Measure Weight

Before weighing the child, take all his /her clothes off. Zero the weighing scale( i.e. make sure the arrow is on zero) Place the child in the weighing pants/hammock, making sure the child is touching nothing Read the child weight .The arrow must be steady and the weight/scale should be read at eye level Record the weight in Kg and to the nearest 100g i.e. 6.4 Kg

How to Measure Height

If a child is more than 85 cm, it should be measured standing up, if he/she is smaller than 85 cm , it should be measured lying down When standing up: Child's heels, back legs, buttocks, shoulders, and head should all touch the back of the board Heels should be Flat on the Floor, and the feet close together Knees, back and neck should be straight Child's arms should be straight down, by his or her side( make sure the child is not grasping the back of the board) Child's head should be straight and looking ahead. A line between his ears and eyes should be parallel to the floor Measurement is always made with 2 people: one holding the child's legs and feet and the other the child's head. Person holding the head reads the measurement

How to Measure Length when Laying Down

One person holds the child's head, making sure the child's head is touching the back of the board. The child's eyes should be looking straight up

The other person holds down the child's knees, pressing the sliding wood piece against the child's heels and soles of his/her feet Align the child with the board
Child's arms should be lying alongside his /her body, and if necessary, the mother can hold the arms down Person holding the feet reads the measurements

How to Measure MUAC and Oedema

MUAC The MAUC is always taken on the left arm

Measure the length of the child's upper arm

Measure the length of the child's upper arm, between the bone at the top of the shoulder, and the elbow bone (the child arm should be bent Mark the middle of the child upper arm with the pen The child's arm should then be relaxed, falling alongside his body Wrap the MAUC tape around the child's arm, such that all of it is in contact with the child's skin. It should be neither too tight ,nor too loose. Read the MAUC in cms, to the nearest mm OEDEMA Gently press both feet for 3 seconds (the time to say 101,102,103) with your thumb. Remove your thumb from the feet. If a yellow pit (depression) remains for several seconds, the child has nutritional oedema