Pediatric Nutrition in Practice

1 Specific Aspects of Childhood Nutrition

Key Words

Nutritional assessment · Feeding history ·

Anthropometry · Growth · Malnutrition

Key Messages

• Nutritional assessment includes feeding history,
  clinical examination and anthropometry; basic hae-
  matological and biochemical indices should also
  be included if possible, in order to identify specific
  nutrient deficiencies


• Careful measurement of growth status and refer-
  ence to standard growth charts is essential in order
  to identify those children who are malnourished


• Addition of skinfold thickness measurements and
  mid-upper-arm circumference allows estimation of
  body composition; however, this is not often calcu-
  lated in routine clinical practice


• There are a number of different ways of defining
  malnutrition, and no definition is universally agreed
  on


• Short-term malnutrition affects weight so that the
  child becomes thin (‘wasting’; weight-for-height
  and BMI below normal reference values)


• Long-term malnutrition leads to poor linear growth
  so that the child will have a low height-for-age
  (‘stunting’)
  
  
  • The point at which deteriorating nutritional status
    demands invasive intervention (tube feeding) in or-
    der to prevent adverse outcomes is unclear and will
    depend on the underlying disease and the overall
    clinical status of the individual child
  
  
  • Serial measurements are required to monitor the
    effectiveness of nutritional intervention
    © 2015 S. Karger AG, Basel
  
  
  
  

Nutritional Assessment

Malnutrition impairs growth, in time leading to

multisystem disease. Nutritional status reflects

the balance between supply and demand and the

consequences of any imbalance. Nutritional as-

sessment is therefore the foundation of nutrition-

al care for children [1]. When judging the need

for nutritional support, an assessment must be

made both of the underlying reasons for any feed-

ing difficulties, and of current nutritional status.

This process includes a detailed dietary history,

physical examination, anthropometry (weight,

length; head circumference in younger children)

using appropriate reference standards, e.g. the

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

1.2 Nutritional Assessment

1.2.1 Clinical Evaluation and Anthropometry

John W.L. Puntis