Diet History and Dietary Intake Assessment 15
1
and interpret this type of assessment; otherwise,
a clinician who is an expert in these procedures
should be used.
Assessment of Barriers
The main dietary problem may be a barrier to in-
take or absorption which has led to the dietary
deficiency. It is important, therefore, to ask some
straightforward questions about the possible bar-
riers. The most likely barriers to intake are listed
in table 1 , and an affirmative answer to any of
these should lead to a tailored course of action
with a view to improving intake. This may involve
other professionals with particular expertise to
deal with the problem, such as speech therapists,
psychiatrists, child feeding behaviour specialists,
social workers, etc. These barriers may not be easy
to resolve, but dietary intake is unlikely to im-
prove if they are ignored.
Dealing with the barriers to absorption may
also lead to referral to other professionals; how-
ever, if the barrier is due to the combinations of
foods consumed, this will need to be assessed
during the taking of the dietary history. During
t h i s pro c e s s , it shou ld b e p os sible to for mu late t he
advice necessary to correct the problem.Ta b l e 1. Dietary assessment of an individual child
Assess barriers to obtaining an adequate dietary intake
Physical problems – chewing, swallowing, use of utensils, consistency of food, etc.
Psychological problems – will only eat certain foods, in particular places, using particular plates, etc.
Parental or socio-economic problems – not enough/too much food available, parents not able to provide correct
food for a particular reason (financial, illness), conflict between child and parent over food
Assess barriers to absorption of nutrients
Physical – diarrhoea, vomiting, regurgitation, use of purgatives, etc.
Dietary – types of foods eaten in combination (this will be assessed after the diet history has been taken –
see below)
Physical activity – is the child very inactive compared to peers, does the child exercise excessively or compulsively
Assess foods and drinks consumed
Talk through and record (as the interview proceeds) a normal day’s meals with the child/parent; use prompt
questions and follow-up questions about foods mentioned. The examples given at breakfast below need to be
tailored to the foods/drinks taken at each meal as the day progresses. Expand to cover a week for complex meals
What do you have for breakfast usually?
Bread – type? – how many slices? – Is anything normally spread on the bread, etc.
Breakfast cereal – type? – milk added? Etc.
What do you usually have to drink?
Do you usually have anything else at this time of the day?
Do you usually have anything before breakfast?
Do you usually have anything in mid-morning?
Do you usually have anything at mid-day?
Do you usually have anything in mid-afternoon?
Do you usually have anything in late afternoon?
Do you usually have anything in early evening?
Do you usually have anything in late evening?
Do you usually take any food or drink to bed?
Do you usually get up in the night to eat or drink anything?
Do you take any vitamins or other food supplements? How often do you take these?
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 14–18
DOI: 10.1159/000367877