1. Pediatric Assessment

2. Assessment of infant and children -Anthropometric : Wt / Age : Wt / Age < 5 th % indicate acute state of malnutrition ( wasting ). Acute nutritional status = Actual wt x100 50 th percentile wt/ht chronic nutritional status = Actual Ht x 100 50 th percentile Ht/age

4. 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 50 th percentile for age 6month3month1month1 week 10%7.5%5%2%

5. 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.

7. -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.

8. -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.

9. Nutrient need: Energy and protein:

11. Fat : 30-54 % of kcal CHO: 30 – 60% of kcal < 10% of total kcal can lead to ketosis. Water : Fluid req: 1 st 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:.

14. 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 Failure to thrife

15. 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.

16. 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.

17. 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.

18. 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

19. Diet Management : Goal: - to provide adequate energy intake for catch-up growth.

20. 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).

21. 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

24. 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 < 5 th % Ht/age is on 10 th %

25. Wt/ht is < 5 th % 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 <5 TH %

30. 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)

31. Pt need catch up growth. Energy = 98 x15 /9 =163 x9 = 1470 kcal /day Protein = 1.6 x15 /9 = 24 gm /day

32. 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

33. Thank you