1. Nutritional Assessment –The Right Perspective
-Dr Shrish Bhatnagar

2. Dr. Shrish Bhatnagar
Consultant Paediatric Gastroenterologist , Eras Lucknow Medical College and Hospital, Lucknow. Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow.

3. Growth Monitoring
Growth Monitoring is a screening tool to diagnose nutritional, chronic systemic and endocrine disease at an early stage.
It has been suggested that growth monitoring has the potential for significant impact on mortality even in the absence of nutrition supplementation or education

4. Aims and Rationale Primary aim: Secondary aims:
To identify children with growth deviation i.e., under nutrition and over nutrition and to identify diseases and conditions that manifest through abnormal growth.
Secondary aims:
1. To discuss health promotion related to feeding, hygiene, immunization and other aspects of the child’s health and behaviour; education of parents to allay their anxiety about their child’s growth.
2. To sensitize paediatricians to use growth charts

5. - Who ?

6. How often to monitor ?
At Birth – Wt, length, HC , Penile length, testicular decent
At every immunization contact till 18 months
18 months – 9yrs – every 6 months weight/ height
> 9yr – yearly Weight &height
> 5 yrs – BMI , PL , SMR Yearly
IAP 2014
Wt= Weight;; HC= Head Circumference
BMI= Body mass Index; SPL= Penile Length; SMR= Sexual Maturity Rate

8. Rigid Board on a hard surface may also be used

11. Correction for MPH Male 9 years Height 119 cms and weight 20 kg
Father is 157 cms, mother is 150 cms,
Formula for target height (MH+FH+/-6.5)
Target Height is 160 ( )

12. Longitudinal
WHO

14. WHO

15. Body Mass Index BMI centile Interpretation < 3 rd Centile
Underweight
> 23 rd adult equivalent
Overweight
> 27 adult equivalent
Obese
Observe
Refer

17. <5 percentile Malnutrition
5th – 85th
Normal
> 85th
Over weight & Obesity

20. Mid parental height

21. Familial Short Stature
10 yr /F
Ht 127 cm Wt = 25
11 yr /F
Ht 131 cm Wt= 26
Familial Short Stature

22. Malabsorption
Celiac Disease

23. Endocrinal

26. Growth Chart Interpretation
Wt age < Ht age < Age Nutritional
Short Stature
Cushings ; Hypothyroid
Prader Willi
Drugs
Malnutrition
Chronic Infections
MAS like Celiac
Ht age < Wt age < Age Endocrinal
Hypothyroid
G.H. Deficiency
RTA
Syndromes --Turner
Ht age < Age < Wt age  Endocrinal
Obesity
Age < Ht age < Wt age  Nutritional

27. Quiz

28. Q1
How many person are required to measure infant length using a infantometer?
One person
Two person
Three person

29. What instrument is used to measure height in children > 2yrs?Q2
What instrument is used to measure height in children > 2yrs?
1. Stadiometer
2. Infantometer
3. Measuring tape and scale

30. All of the statements are true about except Q3
When to refer less <2 yrs based on the findings of the growth chart ?
All of the statements are true about except
Child < 3rd centile for height/ length or weight
If weight < -3 SD (on weight for length chart)
Crossing two major centile
Lack of weight gain for a month in the first 6 months
Lack of weight gain for 2-3 months from 6-12 months

33. Q4
When to refer less > 2 yrs based on the findings of the growth chart ?
All of the statements are true about except
Child < 3rd centile for height or weight for IAP growth charts
Crossing two major centile
Child above and below for MPR for height
When BMI > 23 adult equivalent start watching, when crosses > 27 adult equivalent refer
Lack of growth of 10 cm/ year
Signs of puberty before 8 yr for girls and 9 yr for boys

34. What is the ideal growth chart of preterm babies ? Fenton CDC Q5
What is the ideal growth chart of preterm babies ?
Fenton
CDC
WHO charts
Bailey charts

35. Thank You