Pediatric Nutrition Handbook

An Algorithmic Approach

David Suskind, Polly Lenssen, David Suskind, Polly Lenssen

• Publisher: Wiley-Blackwell
• Year: 2013
• ISBN:
  9781118697184
• Edition: 1
• Topic: Medizin
• Subtopic: Ernährung, Diätetik & Bariatrie

The last decade has seen an explosion of medical information in regards to the nutrition care and management of children. While nutritional therapies have expanded, the treatment choices have become increasingly complex.
This exciting title addresses the extensive amount of information available to practitioners in a concise, accessible fashion via a series of algorithms. It focuses on the normal growing healthy child from birth through adolescence, covering common pediatric diseases and disorders through a series of flows charts which outline step-by-step nutritional processes for pediatric patients. The highly visual format of the book allows the practitioner to make rapid, evidence based choices.

Features:

• Unique algorithm approach to the largest dietetic specialism
• Highly visual approach allows quick decision making
• All algorithms and text built on evidence-based research
• Covers the pediatric phase from birth to adolescence
• Includes common childhood diseases and disorders

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: 0–36 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: Gómez classification (Gómez et al., 1956 ).

First-degree malnutrition	76–90% of theoretical weight for age
Second-degree malnutrition	61–75% theoretical weight for age
Third-degree malnutrition	≤60% 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 0–36-month sex-appropriate WHO growth chart. Do not use a tape measure.

2. Stature (2–20 years): Measure with a stadiometer and plot on a 2–20-year sex-appropriate WHO growth chart.

3. Height-for-age: A measure for chronic malnutrition.

4. Reference: Waterlow classification (1973): height-for-age.

Height deficit (%): (Actual height [cm] ÷ expected height at the 50th percentile for age) × 100
Normal height	95–100%
Mildly stunted	90–95%
Moderately stunted	85–90%
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 (2–20 Years)

Measure for undernutrition and obesity.

1. Calculate (k/m²): (weight in kg) ÷ (height in meters) ÷ (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	5–84th percentile
Overweight	85–94th percentile
Obese	>95th percentile

1.1.5 Ideal Body Weight

1. Methods:

a. Weight at which weight-for-length is 50th percentile for age (0–36 months) or BMI is 50th-percentile BMI for age (2–20 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	90–109%
Mild malnutrition	85–89%
Moderate malnutrition	75–84%
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 0–24 months:

a. Calculate weight gain in g/day and compare to standards: See Appendix A.

b. Calculate linear growth in mm/day (cm/day × 100) and compare to standards. See Appendix B.

3. Children 2–10 years: Calculate weight gain in g/day and compare to standards listed here.

Expected Gain in Weight: >2 Years Old (Fomon et al., 1982 )
Age (years)	Weight (g/day)	Weight (g/day)
	Boys	Girls
2–3	5.7	6.0
3–4	5.5	5.1
4–5	5.4	4.7
5–6	5.5	5.1
6–7	5.9	6.4
7–8	6.7	8.2
8–9	7.8	9.9
9–10	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 (0–36 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 ÷ 4π
• AMA (mm²): (AC [mm] – πTSF)² ÷ 4π
• AFA (mm²): AA – 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....