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Nutrition and

Growth
Development

Afroz lakhani RN,BScN


Objectives for Unit 1

 Conduct nutritional assessment


 Identify and manage nutritional
problems affecting child
 Provide health education to assist
moms to improve the quality of
the nutrition of their children.
(group activity)
Goals of Nutrition
Assessment
 To collect information necessary to
document adequacy of nutritional
status or identify deficits
 To develop a nutritional care plan
that is realistic and within family
context
 To establish an appropriate plan
for monitoring and/or
reassessment
Nutritional Assessment
 Important part of
child’s physical
examination.
 It includes:
1. Dietary Intake
2. Clinical examination
3. Evaluation of
nutritional
assessment
DIETARY INTAKE
 Dietary evaluation is an
important. component of
the child’s assessment.
 Knowledge of child’s
dietary intake is an
essential component of a
nutritional assessment.
 Dietary intake requires
specific questions thus
excellent dietary history
Dietary History
 Most common and easiest method is 24
hr recall.
 Gives you qualitative information.
 Important that it is accurate.
 Create food models for portion size.
 A 3-day record consisting of 2 weekdays
and 1 weekend day.
 Helpful tool when verifying a dietary
history taken by you at initial
assessment.
Dietary History

 Family usual mealtimes


 How money is spent
 Child’s eating habits
 Dental history
 Activity level
 Recent change in weight
 Any culture practices
Additional questions for
Infants
 Birth weight….double,
triple
 Breast-fed or formula/
cow milk
 Any extra fluids like
water/ juice
 Bottle timings??
 Cereal/solid food history
 Any additional
vitamin/minerals
 Stool history
 How often is the feeding
time
Clinical Examination

 Lets do clinical assessment of Nutritional Status


from
(Nursing Care of Infants and Children-WONG)
pg 161 Table 6-1
Evaluation of nutritional
assessment
 After collecting data, evaluate the findings
about the child.
 From the data:
1. Malnourishment
2. At risk of malnourishment
3. Well nourished
 Analyze food diary for complete nutrition.
 Compare findings from clinical examination
and anthropometry with data obtained from
the dietary intake. E.g. signs of anemia and
poor diet of iron suggests lab evaluation line
hemoglobin, hematocrit and transferrin.
Common Nutrition
Problems & Concerns
 Growth
 Diet/nutrient intake
 Feeding problems
 Medication/nutrient
interactions
 Supplements/alternative
diets/megavitamins
 Special diets, i.e. PKU
 Dental and nutrition
issues
 Bowel management
Steps to Evaluating Pediatric
Nutrition Problems

 Screening
 Assessment
 Intervention
 Monitor
 Reassessment
Nutritional Problems and
Management
 Malnourishment can lead to death
 Difficulties with breastfeeding: check
the technique. If deformity (cleft-lip
and palate) can teach mother to
express her milk and give baby by cup
or milk.
 Mom’s issues: death-another woman
who can breast feed. HIV positive
moms should continue if formula feed
is simply impossible.
 Improve food calorie for small children by adding little
oil, margarine or peanut paste.
 Giving small frequent meals.
 Give mashed up food etc if child is not interested.
 Germinated porridge (bacteria less likely to grow thus
reducing episode of diarrhea) than plain one.
 Low growth and development: Iodine intake e.g salt
 Anemia: Iron rich food, long-term developmental
problems, and poor school performance
 A lack of zinc can cause an increased risk of infection
and slow growth
Protein-energy
malnutrition
1. Marasmus:
 Signs of very low weight.
The child will be below 60%
of normal and the third
centile on the growth chart.
 Extreme wasting, very thin,
arms and legs are like
sticks.
 Looks old, worried and
anxious
 Pot belly
 Irritability
 Hunger
 2.
Kwashiorkor
: edema, moon
face, poor
appetite
Management:
 Correct micronutrient
deficiencies. (give multivitamin
supplement, folic acid 1 mg per
day. Dose of vitamin A and Iron
once start to gain weight.
 Small frequent feeds, low in
protein and sodium, high in
potassium and magnesium,
 N/G feed if child is reluctant,
 Correct electrolyte imbalance.
References
 Carpenito, J.L. (2002). Nursing diagnosis: Application to clinical
practice (9th edition) Philadelphia: Lippincott.

 Huether & McCane. (2000). Understanding Pathophysiology (2nd


edition) Mosby

 Huband, Hamilton Brown Barber. (2001). Nursing and Midwifery (1st


Edition) Macmillan
 Illustrated manual of Nursing Practice (2002). 3rd edition.
Springhouse

 Kozier & Erb. (2008). Fundamentals of Nursing (8th edition) New


Jersy: Pearson.

 King, King, Martodipoero. (1978). Primary Child Care. Oxford Medical


Publications.

 Porth.(2005). Pathophysiology (7th edition) Lippincott


Ross and Wilson. (2006).
 Anatomy and physiology (10th edition) Churchill Livingstone