Assessment of infant and children • Anthropometric : Wt / Age : Wt / Age < 5th % indicate acute state of malnutrition ( wasting ) . Acute nutritional status = Actual wt x100 50th percentile wt/ht chronic nutritional status= Actual Ht x 100 50th percentile Ht/age
Recent wt change may indicate acute nutrition issues . In children , the following looses are consider significant : % wt change = [ (actual wt –usual wt) /usual wt] x100 % usual body wt = (actual wt /usual wt ) x100 % Ideal body wt (IBW) = actual wt x100 IBW at 50thpercentile for age
Ht /Age : • Ht / Age <5th % indicate chronic state of malnutrition (stunting) . • Wt /Ht • The wt of child at specific stature regardless of age. • BMI : • For children of age 2-20 • BMI =WT /HT2 X10000 • Head circumference ( birth – 3 years ) : • Less sensitive indicator for nutritional status.
-Biochemical: Albumin, Hemoglobin, cholesterol, TG, Serum glucose. Cholesterol: Children how should be tested at age 2 years or older : - At least on parent how has been found to have high blood cholesterol > 240 mg / dl or greater . - A family history of early heart disease < 55 years in a parent or grandparent .
-Clinical : APGAR score diagnosis or history of chronic or acute condition : A Activity P Pulse G Response to stimuli A Appearance R Respiratory statues immediately at the time of birth .
Nutrient need: Energy and protein:
Fat : 30-54 % of kcal CHO: 30 – 60% of kcal < 10% of total kcal can lead to ketosis . Water : Fluid req: 1st 10 kg 100ml /kg 11-20 kg 1000ml +50 ml /kg (for each kg above . 10) >20 kg 1500 ml + 20 ml /kg (for each kg . above 20) Vitamin and minerals: .
Failure to thrife • Definition: • Weigh loss or lack of weight gain in a child due to chronic illness, a restricted diet, poor appetite , and some socio-environmental issues. • Defined as height or weight less than the third to fifth percentiles
Classification: • Non-organic FTT : • - Results from various environmental and psychosocial factors. • - Associated with abnormal interactions between the caregiver and the infant or child. This can result in an inadequate provision of food or inadequate intake of food. • - Occurs usually in younger than 2 years old . • Organic FTT : • - occurs when there is an underlying medical cause.
Assessment: • History: • Prenatal history : • Smoking • Alcohol consumption • Use of medications • Any illness during the pregnancy • Dietary history : • Determine whether a child is receiving enough energy intake.
How formula is prepared: • - Improperly prepared formula can result in FTT and serious electrolyte imbalances. • Solid foods intake: • - a careful history of the type of food, meal frequency, and volume per feeding. • - If history is difficult to obtain, a food diary of up to 3 days may be requested from the parents.
Current medical condition: • - Infections ,chronic conditions, such as cerebral palsy (CP), , seizures .. • Physical: • - Head circumference, height, and weight • - Vital signs. • - Physical examination may show the following: • - Edema • - Wasting • - Rash or skin changes • - Hair color and texture changes • - Mental status changes • - Signs of vitamin deficiency
Diet Management : Goal: - to provide adequate energy intake for catch-up growth.
Adjust/concentrate infant formula to meet specific nutrient needs: • eg : • - Increase up to 30 kcal/oz. • - 20 kcal/oz formulas + high-calorie food fortifiers, which can be lipids, protein, or carbohydrates. • Supplements for older children may include adding cheese, sour cream, butter, margarine, or peanut butter to meals. Also, high-energy shakes • ( Pedia Sure, Boost).
Multivitamin and mineral supplements, including iron and zinc, usually are recommended . • Tube feeding indicated for cases of severe malnutrition. • continuous nighttime tube feeding may be used to increase their energy intake : - In younger children, using 24 or 27 kcal/oz, or adding calorie fortifiers. - In toddlers, 30 kcal/oz
Case study • Sara is 3.5 years old Saudi female , her vital sign is normal . • Wt =9 kg , Ht = 92 cm • diet Rx : DFA. Wt /age is < 5th % Ht/age is on 10th %
Wt/ht is < 5th % IWt/age =15 kg IHt/age =97 cm % Wt /age =(9 /15) x100 =60 % BMI = [9/(0.92) X (0.92) ] = 10.6 kg/m BMI /Age <5TH %
Acute malnutritional status = (9/13.4) x100 =67.16 % stage 3 (severe acute malnutrition). • Chronic malnutrition status= (92/97) x100= 94.8% stage 0 (mild chronic malnutrition)
Pt need catch up growth. • Energy = 98 x15 /9 =163 x9 = 1470 kcal /day • Protein = 1.6 x15 /9 = 24 gm /day
Nutritional requirment: • Energy 163 kcal /kg =1470 kcal /day • Protein 2.7 gm / kg =24 gm /day • Protein 6.5 % = 24 gm • Cho 53.5 % =197 gm • Fat 40 % = 65 gm