Nutritional Assessment The Right Perspective Dr Shrish Bhatnagar
Nutritional Assessment –The Right Perspective -Dr Shrish Bhatnagar
Dr. Shrish Bhatnagar Consultant Paediatric Gastroenterologist , Eras Lucknow Medical College and Hospital, Lucknow. Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow.
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
Aims and Rationale Primary aim: • 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
- Who ?
How often to monitor ? • At Birth – Wt, length, HC , Penile length, testicular decent • At every immunization contact till 18 months • 18 months – 9 yrs – every 6 months weight/ height • > 9 yr – 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
Rigid Board on a hard surface may also be used
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 (154166)
Longitudinal WHO
WHO
Body Mass Index BMI centile Interpretation < 3 rd Centile Underweight > 23 rd adult equivalent Overweight Observe > 27 adult equivalent Obese Refer
> 85 th Over weight & Obesity 5 th – 85 th Normal <5 percentile Malnutrition
Mid parental height
10 yr /F Ht 127 cm Wt = 25 11 yr /F Ht 131 cm Wt= 26 Familial Short Stature
Malabsorption Celiac Disease
Endocrinal
Ob esi ty Sh St or at t ur e Growth Chart Interpretation Wt age < Ht age < Age Nutritional o Cushings ; Hypothyroid o Prader Willi o Malnutrition Ht age o< Drugs Wt age < Age Endocrinal o Chronic Infections o. Hypothyroid MAS like Celiac o Ht age < Age < Wt age o G. H. Deficiency Endocrinal o RTA Age < Ht age < Wt age o. Syndromes --Turner Nutritional
Quiz
Q 1 • How many person are required to measure infant length using a infantometer? 1. One person 2. Two person 3. Three person
Q 2 • What instrument is used to measure height in children > 2 yrs? 1. Stadiometer 2. Infantometer 3. Measuring tape and scale
Q 3 • When to refer less <2 yrs based on the findings of the growth chart ? All of the statements are true about except 1. 2. 3. 4. 5. Child < 3 rd 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
Q 4 • When to refer less > 2 yrs based on the findings of the growth chart ? All of the statements are true about except 1. 2. 3. 4. Child < 3 rd 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 5. Lack of growth of 10 cm/ year 6. Signs of puberty before 8 yr for girls and 9 yr for boys
Q 5 • What is the ideal growth chart of preterm babies ? 1. 2. 3. 4. Fenton CDC WHO charts Bailey charts
Thank You
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