Nutritional Assessment - Sizing Up Kiddos
- WHO Growth Charts (Z-scores):
- Key indices: WAZ (Weight-for-Age), HAZ (Height-for-Age), WHZ (Weight-for-Height), BAZ (BMI-for-Age).
- Moderate malnutrition: Z-score < -2 SD.
- Severe malnutrition: Z-score < -3 SD.
- MUAC (Mid-Upper Arm Circumference, 6-59 months):
- Severe Acute Malnutrition (SAM): < 11.5 cm.
- Moderate Acute Malnutrition (MAM): 11.5 cm to < 12.5 cm.
- Biochemical Markers:
- Albumin: Chronic indicator ($t½$ ~20 days); ↓ in chronic states.
- Prealbumin (Transthyretin): Acute indicator ($t½$ ~2 days); better for monitoring response to nutritional support.
- ⚠️ Both affected by inflammation, infection, and liver/renal disease.
⭐ WHZ (Weight-for-Height Z-score) is the most sensitive indicator for diagnosing acute malnutrition (wasting).
Energy & Macronutrients - Fueling Tiny Engines
- Energy Needs (EER):
- Use WHO/Schofield equations: $EER = \text{formula based on age, sex, weight, activity}$.
- Approx. RDA: Infants (0-6m) 100-120 kcal/kg/d; Children (1-3y) 80-100 kcal/kg/d.
- Protein:
- Infants (0-12m): 1.5-2.5 g/kg/day.
- Older children (>1y): 1 g/kg/day.
- Carbohydrates: 45-65% total energy.
- Fats: (Essential for brain development)
- Infants (<2y): 30-40% total energy.
- Children (>2y) & Adolescents: 25-35%.
- Maintenance Fluids (Holliday-Segar):
- $Fluid = 100 \text{ml/kg for first } 10\text{kg} + 50 \text{ml/kg for next } 10\text{kg} + 20 \text{ml/kg for rest}$.
⭐ For catch-up growth, energy needs can increase by 20-50% above RDA.
Micronutrients & Deficiencies - Vital Tiny Sparks
| Micronutrient | Key Deficiency Signs | Prophylactic Dose | Treatment Dose |
|---|---|---|---|
| Iron | Anemia (pallor, fatigue, ↓Hb, ↓ferritin) | 1-2 mg/kg/day elemental Fe | 3-6 mg/kg/day elemental Fe |
| Vitamin D | Rickets (craniotabes, rosary, wide epiphyses) | 400 IU/day (infants) | 2000-5000 IU/day / Stoss |
| Vitamin A | Bitot's spots, night blindness | NIS: 1L IU (9mo), 2L IU q6mo till 5yr | WHO: 0.5-2L IU x3 doses (age-dep.) |
| Zinc | Diarrhea, impaired immunity, dermatitis, growth failure | (Specific conditions) | 10-20 mg/day (diarrhea) |
Enteral & Parenteral Nutrition - Tubes & Veins
- Enteral Nutrition (EN): "If gut works, use it!" 📌
- Indications: Functioning GI, inadequate oral intake.
- Contra: GI obstruction, severe ileus, shock, NEC.
- Feeds: Polymeric (intact gut), Semi-elemental (maldigestion), Elemental (severe malabsorption).
- Complications: Aspiration, diarrhea, tube issues.
- Parenteral Nutrition (PN): Bypasses gut.
- Indications: Gut failure (short bowel, severe IBD), prolonged NPO (>5-7 days).
- Components:
- Dextrose: GIR $GIR = (\text{Rate ml/hr} \times \text{Dextrose conc } %) / (\text{Weight kg} \times 6)$; target 4-6 mg/kg/min.
- Amino Acids: 1.5-3 g/kg/day.
- Lipids: 0.5-3 g/kg/day.
- Complications: Line sepsis (CRBSI), PNALD, metabolic (hyperglycemia), refeeding syndrome.
- Refeeding: Monitor PO₄, K⁺, Mg²⁺. Prevent: "Start low, go slow". ⚠️
⭐ Refeeding Syndrome: Severe hypophosphatemia (also ↓K⁺, ↓Mg²⁺) upon re-feeding malnourished patients. Monitor electrolytes; start feeds slowly.
High‑Yield Points - ⚡ Biggest Takeaways
- Exclusive breastfeeding for the first 6 months is paramount for infant health.
- Introduce complementary foods at 6 months alongside continued breastfeeding.
- Prevent iron deficiency anemia with screening and timely supplementation.
- Vitamin D (400 IU/day) is crucial for all breastfed infants.
- SAM management: F-75 for stabilization, F-100 for rehabilitation phase.
- Use low-osmolarity ORS for managing dehydration in acute diarrhea.
- Monitor growth using WHO growth charts regularly for early intervention.
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