Assuring Pediatric Nutrition in the Community

FREQUENTLY USED GUIDELINES:
Failure to Thrive - Assessing Nutrient Needs

HOW DO I DETERMINE NUTRIENT NEEDS FOR CATCH-UP GROWTH?
Gradual increases in nutrient intake (energy, protein, and vitamins and minerals) are recommended. Assessment of an individual’s intake is critical in estimating needs for catch-up growth because of variations among children. The child’s response—weight gain and tolerance of feeding—should be monitored carefully. The best indicator of appropriate nutrient intake is growth. Increasing nutrient intake for catch-up growth can be done by concentrating infant formula, increasing the nutrient density of foods, and supplementing regular intake with enteral products.

What is catch-up growth?
Estimating energy needs
Estimating protein needs
Vitamins and minerals

What is catch-up growth?
Catch-up growth refers to growth at a rate faster than expected. It is seen when a child who has experienced stunted growth due to a nutritional insult receives adequate energy and protein. Depending on the time, severity, and duration of the nutritional insult, a child may "catch-up" to his/her pre-insult percentile channel on the growth chart. Nutrient intake must be sufficient to meet needs for growth and for catch-up growth, and specific requirements depend on the stage of catch-up growth.

How do I estimate energy needs for catch-up growth?
Increases in the amount of energy provided should be based on the child’s current intake. Energy needs for catch-up growth may be 50% greater than the DRI for age. Estimated desirable body weight (estimated using height-age) can also be used to estimate energy needs. For the child who is severely undernourished, increase energy intake gradually to avoid refeeding syndrome. In less acute cases, energy can be increased at a more rapid rate.

Estimated energy requirements for catch-up growth have been published: ·

• Nevin Follino N, ed. Pediatric Manual of Clinical Dietetics, 2nd ed. American Dietetic Association. 2003.
• Ashworth and Millward. Catch-up growth in children. Nutrition Reviews. 44: 157. 1986.

How do I estimate protein needs for catch-up growth?
Goals for protein intake can be estimated with the methods used for energy intake. Estimates based on estimated desirable body weight, rather than actual weight, will generally provide an adequate amount of protein for catch-up growth. Protein needs may be greater than the DRI for age. Estimated protein requirements for catch-up growth have been published. (See Ashworth and Millward)

How do I estimate vitamin and mineral needs for catch-up growth?
Unless frank deficiencies are present or suspected, therapeutic levels of micronutrients are not necessary. Intake should generally be consistent with Dietary Reference Intake levels for age. Some children may require additional potassium (up to 5 mEq per kilogram per day) when the re-feeding process begins.