Pediatric Nutrition in Practice

324 Emmett^

2 4 - h o u r R e c a l l

The child/parent is asked to recall everything
consumed by the child over the previous day
(24 h) [5]. This can be done either face-to-face or
by telephone, but if the child and parent are to be
interviewed together, a face-to-face session might
be more effective. The method relies on memory
and knowledge. The child may not accurately re-
member the foods eaten. It has been found that
children can only recall foods eaten up to a few
hours previously; they sometimes recall phantom
foods which were not eaten, and the more com-
plex the meal, the more likely they are to be inac-
curate in their recall [2]. On the other hand, par-
ents can only aid their child to recall meals at
which they were present, and this is unlikely to be
the case with all meals eaten by the child.
In order to characterise a diet, more than one
recall for each child is necessary. Therefore, the
child and parent need to go through this proce-
dure several times (3 times is probably the mini-
mum), each a few days apart; this is time-con-
suming for both the subjects and the staff.

Food Frequency Questionnaires

The child /parent is presented with a list of foods
and drinks and asked to indicate the frequency
with which they are usually consumed by the
child from a predetermined list of frequencies [6].
Sometimes the list includes an indication of the
usual portion size consumed. Such a list can be
administered as a self-completion questionnaire
or in an interview by trained staff (particularly if
literacy is a problem).
It is imperative that the food frequency ques-
tionnaire (FFQ) is designed for the particular
population under study; otherwise, it will be in-
effective and could be misleading [6]. The food/
drinks listed must be the ones that this popula-
tion are likely to consume; this is specific to the
age, country, ethnicity and background of the

subjects. For example, when studying infants,

formula milk, breast milk and infant food must

be covered, and when studying children living in

different countries, foods specific to each coun-

try must be covered.

The concept of the frequency of eating differ-

ent foods is cognitively quite difficult, and it is

unlikely that a child below the age of 12 years

would be able to cope with it; therefore, parents

will usually need to complete the FFQ on behalf

of the child [2]. If they are doing this at home,

then it would be best done in consultation with

the child (and others with knowledge) about

meals eaten away from the parent. Portion sizes

are also a difficult concept to communicate and

interpret. The simplest answer is to allocate stan-

dard portion sizes, but these must be adjusted to

the age of the child.

Although an FFQ is relatively cheap and quick

to use, the interpretation of the answers given to

produce calculated nutrient intakes is not simple

and requires expert input. It is important to plan

for this stage in advance.

Nutrient Analysis

Nutrient analysis of the food records and 24-hour

recalls collected requires trained staff and a suit-

able dietary analysis programme which can ac-

commodate all the foods eaten and provide up-

to-date nutrient contents for all the nutrients of

interest [7]. Obtaining this type of analysis pack-

age needs careful thought, since foods change

over time and off-the-shelf versions of these pack-

ages do not always cover culturally specific foods,

new foods on the market or some specific nutri-

ents. It is best to involve an expert dietician/nutri-

tionist in this process as the interpretation of the

records requires an intimate knowledge of foods.

For an FFQ, nutrient analysis is only required for

a list of representative foods; thus, this stage is

much quicker to deal with, but it does not provide

individual details of foods consumed.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 322–325

DOI: 10.1159/000367864