1. SBH Outpatient Nutrition Services / Pediatrics Romilda Grella, MS, RD, CDN Outpatient Registered Dietitian St. Barnabas Hospital - Ambulatory Clinic 4487 Third Avenue, Bronx, NY 10457-2594 Tel: 1-718-960-5007 Pager: 1-877-714-4681 or **807 Email: rgrella@stbarnabas-ny.orgrgrella@stbarnabas-ny.org

2. The goal of nutrition management of children support optimal growth and development encourage physical activity and fitness ensure the availability of adequate nutrient stores for growth demands establish healthful eating habits that will lower the risk of chronic disease.

3. Pediatric Patients are referred to Nutrition Services by the Pediatrician. Based on: History of poor or inadequate intake Weight/Height <10 th %ile Overweight >85 th %ile Obese >95 th %ile Multiple food allergies/intolerances Known food/drug interaction Following special diets Have risk factor including obesity related medial conditions such as hyperlipidemia, hyperinsulinemia and high blood pressure. Positive risk factors for type 2 diabetes, insulin resistance, cardiovascular disease risk factors. Limited access to food Food, nutrition related knowledge deficit Physical inactivity Dental carries

4. Initial Pediatric Nutritional Assessment Subjective:  Appetite  % meals consumed  GI distress  Weight history  Medications/vitamins  Food Allergies/food intolerances  Food Preferences  Food recall (breakfast, lunch, dinner & snack)

5. Initial Pediatric Nutritional Assessment Objective: Diagnosis Past Medical History Height Height/age %ile Weight Weight/age %ile Labs Medications Nutrition Assessment Flowsheet

6. Initial Pediatric Nutritional Assessment Assessment: Assessment of nutritional risk level Diet tolerated Weight status Nutritional status Estimated caloric needs Estimated protein needs

7. Initial Pediatric Nutritional Assessment Plan: Goals Recommendations Follow up Referral to other services

8. Growth Chart Boys 2-20 yrs, Weight (2000)

9. Growth Chart Boys 2-20 yrs, Height (2000)

10. BMI 2-20 years with 85 th percentile

11. Growth Chart Girls 2-20 yrs, Weight (2000)

12. Growth Chart Girls 2-20 yrs, Height (2000)

13. BMI 2-20 years with 85 th percentile

14. Adapted from http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf

15. SBH Nutrition Services Department Standards of Care for Pediatric

16. Calculate estimated needs appropriate for age. Plot patient on growth chart weight for age at the 50 th % Using the weight from the 50 th % (kg) multiply by the age appropriate standards of care to determine patients estimated caloric and protein needs Estimated Caloric Needs: ____ based on ____Kcal/kg for age @ ( ___Kg 50th%ile wt for age NCHS) Estimated Protein Needs: ____ based on ___ gm/kg/day for age @ ( ___Kg 50th%ile wt for age NCHS)

17. Example: 15 yr F, wt: 288 lbs (130.6 kg), ht: 62 in (157 cm), BMI: 52.9 Using the female growth chart, look up wt at 50 th %ile wt for age, 15 yr. Estimated Caloric Needs: 2132 based on 40 Kcal/kg for age @(53.3 Kg 50th%ile wt for age NCHS) Estimated Protein Needs: 43 based on 0.8 gm/kg/day for age @(53.3 Kg 50th%ile wt for age NCHS) Growth percentile: >97th Wt/age %ile weight/age percentile: >97 th Ht/age %ile height/age percentile: <25 th 50 th %ile, weight for age 50 th percentile wt for age: 53.3 kg 50 th %ile, height for age 50 th percentile wt for age: 162.2 cm % BMI: >97th

18. Reinforcing the Childs ability to self-manage his or her own food intake in an important component of successful life long weight management.

19. Websites www.choosemyplate.gov www.fns.usda.gov www.kidshealth.org www.KidsEatRight.org www.eatsmart.org www.letsmove.org www.nourishinteractive.com