Paediatrics
Anthro
Wt under 2 yrs- bare/no nappy (nappy can add 150g), use baby scales, newborns: record to nearest 10g, infants: record to nearest 100g
length - length board with head and food board, 2 people for accurate measure, supine, neck/spine/hips/legs straight, record to last 0.1cm
head circumference - particularly under 3 months
wt over 2 yrs - shoes off, sit or stand on scales, record to nearest 100g, wheel chair scales available
ht over 2 yrs - feet flat, slightly apart, record to 0.1cm
ht estimations (knee height) - over 2 yrs, measured left side, used to develop a trend
mid upper arm circumference - severe malnutrition under 11.5cm
skinfold thickness - estimate fat stores, age related standards to monitor trends
faltering growth - slower growth than expected, wt >2 percentiles below ht percentile, wt for ht <5th percentile, growth consistently below 3rd percentile, crossing 2 or more percentile bands (wt for age, ht for age) over 6 months
Growth charts
WHO - >37 weeks, 0-2 yrs, ideal growth, 2nd-98th percentile
CDC - 2-18 yrs, NHMRC, 3rd-97th percentile, BMI z score charts used in malnutrition diagnosis
collect a hx, and monitor trends
fenton growth chart - premature, <37 weeks, corrected gestational age (actual age in weeks - weeks preterm = corrected age)
BMI over 85th percentile is overweight, over 95th percentile is obese
Malnutrition
Paediatric malnutrition screening tool - repeated weekly on admission
poor growth, impaired cognitive development, decreased immunity, impaired wound healing, increased LOS, increased morbidity and mortality
protein and energy intake vs requirements
MUAC, growth velocity (z scores - 0-2 yrs), % wt loss, vital signs, chronicity, nutrient imbalance
Interventions
breast fed - adequate volumes over 24hrs, lactation consultant, top up with EBM/fortified EBM (expressed breast milk) after feeds
formula fed - check daily volume, check timing of feeds, formula preparation, formula changes, increase formula strength, add CHO or fat
stop correcting gestational age from 24 months corrected gestational age
