1. Nutritional Assessment- Failure to Thrive Eileen Cress, MS, RD, LDN August 9, 2012

2. Failure to Thrive Inadequate physical growth or the inability to maintain the expected rate of growth over time. Undernutrition

3. Early Detection First checkups key to early detection Calculate weight gain and compare to minimum recommended infant gain of 15 to 30 g per day after 2 weeks of age, allowing for regain of birth weight (1)

4. Etiology Mixed etiology is common Functional vs organic More often result of psychosocial problems. Gahagan and Holmes 1998: Spend more time on history than other investigative studies first. (1)

5. Nutritional Assessment Anthopometrics- weight, height, head cm Medical History including weight change Physical Exam Medication and labs Diet evaluation: meal environment, patterns, intake, food availability Feeding behavior and feeding skill development Caregiver knowledge/myths/behaviors

6. Nutritional Assessment Financial resources Food intolerances or allergies Cultural, religious, or ethnic preferences Family viewpoint regarding nutrition and feeding Estimate nutrient needs Evaluate adequacy of nutrition regimen

7. Nutritional Assessment Evaluate Meal Environment Time spent Mood Seated at a highchair or table? Infants properly held?

8. NutritionalAssessment Evaluate Meal Patterns/Intake-infants Infant feeding- amount of breastmilk or formula, other ( juice, water, cereal) Formula preparation Presence of reflux /vomiting/diarrhea Frequency of feedings

9. NutritionalAssessment Evaluate Meal Patterns / Intake Infant Feeding Guidelines: Birth–1 month: 2-4 oz, 6 or more times/d 1-3 months: 4-6 oz, 5-7 times/d 3-6 months: 6-7 oz, 4-6 times/d 6-9 months: 6-8 oz, 4-6 times/d 10-12 months: 7-8oz, 3 times /d

10. NutritionalAssessment Feeding behavior and feeding skill development-infants Transition to solids 4-6 months Transition to diced and finger foods 9-12 months, including all food groups Use of cup 10-12 months Eliminate bottle at 12 months

11. NutritionalAssessment Evaluate Meal Patterns/Intake-toddlers Toddlers- grazing, portions of food items, frequency of meals/snacks. Food Intake Diary- 3-day including one weekend day

12. Nutritional Assessment Common Problems Formula over- dilution Large amount of baby cereal in bottle Excess juice or other beverage No feeding schedule No high chairs/ Infants not held to bottle feed Multi caregivers Distractions

13. Nutritional Assessment Estimating nutrient needs Energy and protein needs determined by using Dietary Reference Intakes of the Food and Nutrition Board, National Academy of Sciences.

14. Nutritional Assessment Catch up growth Calories Kcal/kg age x IBW for ht (kg) = kcal/kg actual wt actual wt/kg Protein Gm/kg for age x IBW for ht (kg) = gm/kg actual wt actual wt (kg)

15. Nutritional Assessment Possible Interventions: Caregiver Education Develop feeding schedule Concentrated formulas Supplemental formulas Food additives to puree foods

16. Nutritional Assessment Food Additives to Enhance Calories (4) Food ItemCalories Infant cereal9/ Tbsp Nonfat dry milk25/ Tbsp Cheese, melted120 /oz Margarine101/ Tbsp Evaporated milk40 / oz Vegetable oil110 / Tbsp Strained infant meats100-150 / jar Glucose polymers, powdered or liquid 30 / Tbsp

17. Suggested Websites http://abbottnutrition.comhttp://abbottnutrition.com (Abbott Nutrition/ Similac products) http://www.gerber.comhttp://www.gerber.com ( Gerber/Nestle Good Start products) http://www.mjn.comhttp://www.mjn.com (Mead Johnson/Enfamil products) http://eatright.org http://www.mypyramid.gov http://www.heinzbaby.com http://www.healthychildren.org http://www.keepkidshealthy.com

18. References 1. Gahagan S., Holmes R. A Stepwise Approach to Evaluation of Undernutrition and Failure to Thrive. Pediatr Clin North Am. 1998 Feb; 45(1): 169-87. 2. A.S.P.E.N. Board of Directors. Nutrition Assessment: Pediatrics. J Parenter Enteral Nutr January 2002 26: no.1SA. 3. Mascarenhas, M R., Zemwl, B, Stallings, V.A. Nutritional Assessment in Pediatrics. Nutrition 1998. 14(1):105- 115. 4.Samour, P.Q., King, K. Pediatric Nutrition. 2012, 4 th ed. Jones and Bartlett., Sudbury, MA..