Assuring Pediatric Nutrition in the Community

FREQUENTLY USED GUIDELINES:
Evaluation of Nutritional Status

Table of Contents

WHAT DOES A NUTRITONAL ASSESSMENT INCLUDE?

ANTHROPOMETRIC PARAMETERS AND GROWTH
Weight, stature (length or height) and head circumference
Growth charts
Stature and weight proportionality: weight for stature, Body Mass Index
Other parameters: skinfold and arm circumference measurements
Estimations of stature: arm span, knee height, crown-rump sitting height
Expected weight and stature: height-age, weight-age, expected weight, midparental height
Specialty growth charts
References

DIETARY INTAKE
Methods of data collection
Questions to ask to assess nutrient intake, behaviors, relationships, attitudes, feeding skills, development
Standards to evaluate adequacy of intake
References

MEDICAL ISSUES
Common drug/nutrient interactions
References

DEVELOPMENT
Assessment of feeding skills
References

BEHAVIOR
Why should I assess behaviors related to feeding?
Evaluating behavior-related problems
Evaluating parent and child interactions
Evaluating environmental factors
Evaluating physiologic problems
References

What does a nutritional assessment include?

Assessment of a child’s nutritional status includes evaluation of several sets of indicators:

Anthropometric indicators (e.g., weight, stature, and skinfold measurements) provide information about a child's physical growth. Measurements can be compared to growth charts to help determine nutritional risk, and over time, they provide information about a child’s long term nutritional status.

Dietary information in a nutritional assessment can be affected by a variety of factors, including physical, environmental and social influences. Nutrient intake, developmental appropriateness of foods offered, and social and environmental influences are evaluated in this portion of the assessment. Behaviors around food and eating should be examined as well.

Biochemical indicators (laboratory values) can provide information about a child’s macro- and micronutrient stores; e.g., a low serum albumin might reveal a risk for protein deficiency. Hemoglobin and hematocrit values can provide information about iron status. Cut-off levels vary for specific institutions. The use of norms for adults is not necessarily appropriate in pediatric populations. Medical conditions, including fluid imbalances, and drug-nutrient interactions must be taken into consideration when interpreting lab values.

Clinical indicators are physical signs of nutritional status; e.g., fatigue, dry or scaly skin, and lackluster hair.

Medical conditions that may alter intake and/or growth should be considered in the assessment. Possible drug-nutrient interactions should be evaluated.