Nutritional Assessment
An essential element in the assessment is evaluation of the child’s nutritional
status from a physical examination and a biochemical perspective, as well as
the usual dietary intake. It is important to collect data from the child and fam-
ily members regarding nutrition habits. Inquire about community access to
variety of food types and factors impacting food choices, such as location of
stores, fast-food choices due to time constraints, and economic barriers to pur-
chase of sufficient quantities of fresh fruits and vegetables and low-fat cuts of
meat, as well as fish and fowl choices. If the family practices vegetarianism,
inquire about the specific foods allowed and assess adequacy of intake of nutri-
entsfrom all food groups. Assess overweight(85–95% for body mass index
[BMI]) or obesity, weight above 95th percentile for BMI in the child or family
members because family eating habits will play a large part in childhood obe-
sity moving into adulthood.Culture alertAssess dietary restrictions due to ethic cultural beliefs and taboos.Nutritional assessment should include
Dietary intake- Dietary history by 24-hour recall, food diary, or record to note the
nature and amount of foods and beverages consumed
Clinical examination - Chart weight, height, and head circumference (for infants) on a
growth chart; if child is <5th percentile or >95th, an insufficient or
excess intake is likely present. - Calculate body mass index (BMI):Weight in kilograms divided by
height in meters squared. - Delay of development of secondary sex characteristics(i.e., breasts
in girls, pubic hair, testes) can indicate malnutrition or vitamin A and
D deficit or excess. - Skin changes such as loss of skin turgor,elasticity of the skin, or
edema,swelling or puffiness indicating dehydration or fluid overload. - Delayed wound healing (poor protein intake/malnutrition).
- Flabby skin or stretch marks can indicate food/excesses.
- Other physical changes noting malnourishment or excess dietary intake
will be noted in the discussion of physical assessment.
Biochemical tests:Blood analysis of nutrients, electrolytes, and protein products
Hemoglobin and hematocrit; low levels may reveal inadequate protein
intake.
Albumen, protein, creatinine, nitrogen; low levels could indicate low
protein intake.CHAPTER 3/ Pediatric Assessment^35