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Chapter 1
General Nutrition
1.1 General Pediatric Nutrition Assessment
Cheryl Davis and the Clinical Nutrition Department
The authors of the nutrition assessment chapters would like to acknowledge the contributions of the clinical nutrition staff over many years in developing standard guidelines.
1.1.1 Weight
1. Weigh on digital or calibrated scale (infant scale: 0โ36 months; standing scale >3 years).
2. Plot on age- and sex-appropriate World Health Organization (WHO) growth chart.
3. Weight-for-age: A measure for acute malnutrition.
4. Interpretation: Gรณmez classification (Gรณmez et al., 1956 ).
| First-degree malnutrition | 76โ90% of theoretical weight for age |
| Second-degree malnutrition | 61โ75% theoretical weight for age |
| Third-degree malnutrition | โค60% theoretical weight for age |
1.1.2 Height or Length
1. Recumbent length (up to 36 months): Measure on length board with one person at the head and one at the feet, and plot on a 0โ36-month sex-appropriate WHO growth chart. Do not use a tape measure.
2. Stature (2โ20 years): Measure with a stadiometer and plot on a 2โ20-year sex-appropriate WHO growth chart.
3. Height-for-age: A measure for chronic malnutrition.
4. Reference: Waterlow classification (1973): height-for-age.
|
| Normal height | 95โ100% |
| Mildly stunted | 90โ95% |
| Moderately stunted | 85โ90% |
| Severely stunted | <85% |
1.1.3 Weight-for-Length (Up to 36 Months)
Measure for acute malnutrition as well as obesity.
1. Plot on a 0-to 36-month sex-appropriate WHO growth chart.
| High risk for underweight | <5th percentile |
| Moderate risk for underweight | <10th percentile |
| At risk for overweight | >85th percentile |
| Overweight | >95th percentile |
1.1.4 Body Mass Index (BMI) in kg/m2 (2โ20 Years)
Measure for undernutrition and obesity.
1. Calculate (k/m2): (weight in kg) รท (height in meters) รท (height in meters).
2. Plot on a 2- to 20-year sex-appropriate WHO growth chart.
3. Interpretation: Barlow SE; Expert Committee, 2007.
| Underweight | <5th percentile |
| Healthy weight | 5โ84th percentile |
| Overweight | 85โ94th percentile |
| Obese | >95th percentile |
1.1.5 Ideal Body Weight
1. Methods:
a. Weight at which weight-for-length is 50th percentile for age (0โ36 months) or BMI is 50th-percentile BMI for age (2โ20 years).
b. Weight at the 50th percentile at the age that matches the height-for-age.
2. % Ideal body weight (IBW) = Actual weight/IBW.
3. Interpretation: McLaren and Read, 1972.
| Normal nutrition | 90โ109% |
| Mild malnutrition | 85โ89% |
| Moderate malnutrition | 75โ84% |
| Severe malnutrition | <75% |
1.1.6 Growth Velocity or Incremental Growth
1. Detect abnormal rates of growth or weight gain before child is at extremes on growth chart; monitor efficacy of nutrition therapy.
2. Infants 0โ24 months:
a. Calculate weight gain in g/day and compare to standards: See Appendix A.
b. Calculate linear growth in mm/day (cm/day ร 100) and compare to standards. See Appendix B.
3. Children 2โ10 years: Calculate weight gain in g/day and compare to standards listed here.
|
| Age (years) | Weight (g/day) | Weight (g/day) |
| | Boys | Girls |
| 2โ3 | 5.7 | 6.0 |
| 3โ4 | 5.5 | 5.1 |
| 4โ5 | 5.4 | 4.7 |
| 5โ6 | 5.5 | 5.1 |
| 6โ7 | 5.9 | 6.4 |
| 7โ8 | 6.7 | 8.2 |
| 8โ9 | 7.8 | 9.9 |
| 9โ10 | 9.1 | 11.2 |
1.1.7 Specialty Growth Charts
1. Premature: Plot for gestational age until 50 weeks; then correct for prematurity on standard WHO growth charts until 24 months.
2. Charts for achondroplasia, cerebral palsy, Down syndrome, Noonan syndrome, Prader-Willi syndrome, Turner syndrome, and Williams syndrome are available. Use in conjunction with standard WHO growth charts.
1.1.8 Occipital Frontal Circumference (0โ36 months)
1. Plot on sex-appropriate WHO growth charts.
2. Interpretation:
a. Rapid increase in rate of growth may indicate hydrocephalus.
b. Decrease in rate of growth may indicate developmental delay; associated with malnutrition.
3. Note if patient has a shunt.
1.1.9 Arm Muscle and Fat Stores ( >12 months)
1. Use to detect serial changes in body composition; only valid when repeat measurements are made by the same observer and interpreted over time.
2. Measure mid-upper-arm circumference (AC) and triceps skin fold thickness (TSF) and calculate arm area (AA), arm muscle area (AMA), and arm fat area (AFA).
a. Calculations
- AA (mm2): (AC [mm])2 รท 4ฯ
- AMA (mm2): (AC [mm] โ ฯTSF)2 รท 4ฯ
- AFA (mm2): AA โ AMA.
3. Compare to standards (limitation: data from whites only). See Frisancho (1981).
1.1.10 Clinical Evaluation
1. Nutritional status is affected not only by the nutritional intake but also by developmental status, disease states, medications, and surgical/medical procedures.
2....
