Nutritional Assessment –The Right Perspective -Dr Shrish Bhatnagar

Dr. Shrish Bhatnagar Consultant Paediatric Gastroenterologist , Eras Lucknow Medical College and Hospital, Lucknow. Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow.

Growth Monitoring Growth Monitoring is a screening tool to diagnose nutritional, chronic systemic and endocrine disease at an early stage. It has been suggested that growth monitoring has the potential for significant impact on mortality even in the absence of nutrition supplementation or education

Aims and Rationale Primary aim: Secondary aims: To identify children with growth deviation i.e., under nutrition and over nutrition and to identify diseases and conditions that manifest through abnormal growth. Secondary aims: 1. To discuss health promotion related to feeding, hygiene, immunization and other aspects of the child’s health and behaviour; education of parents to allay their anxiety about their child’s growth. 2. To sensitize paediatricians to use growth charts

- Who ?

How often to monitor ? At Birth – Wt, length, HC , Penile length, testicular decent At every immunization contact till 18 months 18 months – 9yrs – every 6 months weight/ height > 9yr – yearly Weight &height > 5 yrs – BMI , PL , SMR Yearly IAP 2014 Wt= Weight;; HC= Head Circumference BMI= Body mass Index; SPL= Penile Length; SMR= Sexual Maturity Rate

Rigid Board on a hard surface may also be used

Correction for MPH Male 9 years Height 119 cms and weight 20 kg Father is 157 cms, mother is 150 cms, Formula for target height (MH+FH+/-6.5) Target Height is 160 (154- 166)

Longitudinal WHO

WHO

Body Mass Index BMI centile Interpretation < 3 rd Centile Underweight > 23 rd adult equivalent Overweight > 27 adult equivalent Obese Observe Refer

<5 percentile Malnutrition 5th – 85th Normal > 85th Over weight & Obesity

Mid parental height

Familial Short Stature 10 yr /F Ht 127 cm Wt = 25 11 yr /F Ht 131 cm Wt= 26 Familial Short Stature

Malabsorption Celiac Disease

Endocrinal

Growth Chart Interpretation Wt age < Ht age < Age Nutritional Short Stature Cushings ; Hypothyroid Prader Willi Drugs Malnutrition Chronic Infections MAS like Celiac Ht age < Wt age < Age Endocrinal Hypothyroid G.H. Deficiency RTA Syndromes --Turner Ht age < Age < Wt age  Endocrinal Obesity Age < Ht age < Wt age  Nutritional

Quiz

Q1 How many person are required to measure infant length using a infantometer? One person Two person Three person

What instrument is used to measure height in children > 2yrs? Q2 What instrument is used to measure height in children > 2yrs? 1. Stadiometer 2. Infantometer 3. Measuring tape and scale

All of the statements are true about except Q3 When to refer less <2 yrs based on the findings of the growth chart ? All of the statements are true about except Child < 3rd centile for height/ length or weight If weight < -3 SD (on weight for length chart) Crossing two major centile Lack of weight gain for a month in the first 6 months Lack of weight gain for 2-3 months from 6-12 months

Q4 When to refer less > 2 yrs based on the findings of the growth chart ? All of the statements are true about except Child < 3rd centile for height or weight for IAP growth charts Crossing two major centile Child above and below for MPR for height When BMI > 23 adult equivalent start watching, when crosses > 27 adult equivalent refer Lack of growth of 10 cm/ year Signs of puberty before 8 yr for girls and 9 yr for boys

What is the ideal growth chart of preterm babies ? Fenton CDC Q5 What is the ideal growth chart of preterm babies ? Fenton CDC WHO charts Bailey charts

Thank You