Pediatric Nutrition in Practice

Clinical Evaluation and Anthropometry 7

1

WHO standard growth charts [2] (see Chapter
4.1), and basic laboratory indices (see Chapter
1.2.4) if possible. In addition, skinfold thickness
and mid-upper-arm circumference measure-
ments provide a simple method for estimating
body composition [3].

Nutritional Intake

Questions regarding mealtimes, food intake and
difficulties with eating should be part of routine
history taking and give a rapid qualitative impres-
sion of nutritional intake (see Chapter 1.2.2). For
a more quantitative assessment, a detailed dietary
history must be taken which involves recording a
food diary or (less commonly) a weighed food in-
take. This would usually be undertaken in con-
junction with an expert paediatric dietician. Use of
compositional food tables or a computer software
programme allows these data to be analysed so that
a more accurate assessment of intake of energy and
specific nutrients can be made. When considering
whether such intakes are sufficient, dietary refer-
ence values provide estimates of the range of en-
ergy and nutrient requirements in groups of indi-
viduals [4]. Many countries have their own values
and international values have been published by
the Food and Agriculture Organization/WHO/
United Nations University. Dietary reference val-
ues are based on the assumption that individual
requirements for a nutrient within a population
group are normally distributed and that 95% of the
population will have requirements within 2 stan-
dard deviations (SD) of the mean (see Chapter
1.3.1). In a particular individual, intakes above the
reference nutrient intake are almost certainly ade-
quate, unless there are very high disease-induced
requirements for specific nutrients, while intakes
below the lower reference nutrient intake are al-
most certainly inadequate.

Taking a Feeding History

A careful history is an important component of

nutritional assessment. Listed below are some of

the questions and ‘cross-checks’ that are integral

to an accurate feeding/diet history:

Infant: is the baby being breastfed or formula

fed?

For breastfed infants:

• How often is the baby being fed and for how
  long on each breast? Check positioning and
  technique


• Are supplementary bottles or other foods of-
  fered?
  For formula-fed infants:


• What type of formula? How is the feed made
  up? i.e. establish the final energy content/
  100 ml


• Is each feed freshly prepared?


• How many feeds are taken over 24 h?


• How often are feeds offered: every 2, 3 or 4 h?


• What is the volume of feed offered each time?


• How much feed is taken?


• How long does this take?


• Is anything else being added to the bottle?
  For older children:


• How many meals and snacks are eaten each
  day?


• What does your child eat at each meal and
  snack (obtain 1- or 2-day sample meal pat-
  tern)


• How do the parents describe their child’s ap-
  petite?


• Where does the child eat meals?


• Are there family mealtimes?


• Are these happy and enjoyable situations?


• How much milk does the child drink?


• How much juice does the child drink?


• How often are snacks/snack foods eaten?
  (Further details are provided in Chapter
  1.2.2.)

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 6–13
DOI: 10.1159/000360311