Nutritional Assessment of Children

Dr. Shankar Prasad Yadav

Assistant Professor
Department of Pediatrics & Adolescent Medicine
BPKIHS, Dharan
Nutrition
 The study of food in relation to the physiological
process (Growth, energy production, repair of body
tissue and basal metabolism) that depend on its
absorption by the body

 Nutrition is concerned with how food is used by the

body, and changing composition of the body is an
index of nutritional status and reflection of what is
eaten.

 Optimal nutrition is the foundation of the good health

Source of Diet

Protein:
 Meat product, cereal product, milk products, vegetables

Fat:
 Saturated: Milk product, cereals products, meat products,
vegetable

 PUFA: Chips, cereals, meat, vegetable, fat spread

Contd..

Carbohydrate:
 Starch: Cereals, potatoes,Vegatables

 Sugars: Cereals, Sucrose, confectioneries,

beverages

 Dietary fibres: Bread, vegetables, fruits and nuts

Energy expenditure in Children

Energy Expenditure

Growth Thermogenesis Physical activity Basal Metabolism

2% 8% 25 % 65 %
Nutritional assessment

 Nutritional assessment is the evaluation of an individual’s

nutritional status and requirements

 There are five principal approaches to nutritional assessment:

Anthropometric measurement
Dietary measurement
Biochemical measurement
Clinical measurement
Functional measurement
Why Growth monitoring?

 Part of Normal Child Assessment:

Parental/Dietary counseling
 Early Diagnosis of Nutritional Problems
– Undernutrition
– Overnutrition
 Diagnosis of disease states
– Acute
– Chronic
 Monitoring for success of intervention/treatment
How to Measure Growth?

Head/chest
Mid-arm circumference
circumference
Skinfold
Length/Height thickness

Weight
 Measuring Growth
Nutritional Anthropometry

Anthropometry (Science of body measurements)

Simplest and most practical tool
 Weight
 Height/Length
 Head circumference
 Chest circumference
 Mid-arm circumference
Head circumference
MUAC
Limitations of Anthropometry

 Changes in anthropometry take time

 Difficult to distinguish lean from adipose tissue; fails

to distinguish between well-built and obese

 Weight based parameters unreliable in presence of

edema, tumor load etc.
Anthropometric Techniques
Measurements: Weight

 Weighing scales should be portable, durable and

sensitive

 Remove or minimize clothing

 Remove any zero errors

 Ensure stabilization of needle/reading before

recording
 Measurement: Length/Height

Recumbent length: < 2yrs

(By infantometer)

Height: > 2 yrs by using stadiometer: > 2 yrs

Skin fold thickness
Measurement: Mid-arm-circumference

 Remove clothings over arm

 Flex the arm to 90 degrees

 Locate the tip of acromion process and mark the

midpoint from this to tip of elbow

 Extend the arm and measure to nearest 0.1 cm by

overlap technique
Interpretation of Anthropometry
Anthropometric Indices

 Weight for Age

 Length/Height for Age: Measure of stunting

 Weight for Length/Height: Measure of stunting

 Body Mass Index

Importance of Correct Age

 Any error in interpretation of age makes

anthropometry fruitless

 Ask exact date of birth or calculate from documents

to the nearest month

 If not recalled, use local calenders or recollection

from important events
Growth charts: References

Growth evaluation done in context of normal reference

population
 NCHS/CDC Growth Charts: Based on growth of
normal American children
 WHO Growth Standards: Based on growth of healthy
breast-fed children
 Local growth charts: Based on growth of healthy
children from local areas
How to Read Charts/Tables
Conclusions

 Measure Carefully using accurate tools

 Compare carefully against reference charts
– Use correct age
– Use sex-specific chart
– Use Z score or %ge of median cut-offs
– Know the cut-offs and their importance
Dietary nutritional assessment

 Dietary assessment should be done by pediatric

dietitian

 Ask about detail intake of cereals, pulses, fruits, egg,

meat

 The food eaten reflect usual dietary habit

Contd..

 Assessment of dietary intake is based on daily

dietary intake

 Dietary assessment of exclusively breast fed infant

Biochemical nutritional assessment

 It requires measurement of nutrient concentration of

blood, urine, fluid or tissue

 In certain conditions, circulating concn of nutrients are

not accurate measurement of tissue store: vit. C, iron
& calcium

 Blood urea reflect not only renal parameter but also

protein intake
Contd..

 Alkaline phosphatase is a sensitive indicator of

nutritional rickets and osteomalasia

 Ferritin reflects total body iron store

Clinical nutritional assessment

 Sign of pure or single nutrient deficiencies rarely

occur alone, glossitis or angular stomatitis are
nonspecific

 Physical examination is interpreted in association

with anthropometric, dietary and biochemical
nutritional assessment
Contd..

 Physical sign is late manifestation of nutritent

deficiency, occurring after tissue store have been
depleted
 Deficiency signs such as hair changes, anemia,
xerosis, cheilosis, dental carries should be actively
looked for
Thank You