Growth, Development, and Nutritional Assessment
Why it matters
Growth is the pediatric equivalent of vital signs. Questions test whether you can interpret anthropometrics, recognize malnutrition phenotypes, and choose the right nutritional intervention.
Core concepts
- Anthropometric indices: weight-for-age, length/height-for-age, weight-for-length or BMI-for-age, and head circumference. Use WHO standards under 2 years and CDC growth charts thereafter.
- Malnutrition classification: acute (wasting, low weight-for-height) versus chronic (stunting, low height-for-age); edema defines kwashiorkor-like severe acute malnutrition.
- Catch-up growth: requires adequate energy and protein; calculate estimated needs and monitor velocity.
- Micronutrients: iron, zinc, vitamin D, B12, and fat-soluble vitamins (A, D, E, K) in cholestasis or malabsorption.
- Refeeding syndrome: risk with severe malnutrition; monitor electrolytes (phosphate, potassium, magnesium) and start feeds cautiously.
Traps
Candidates confuse stunting with wasting, or forget that a normal weight-for-age can mask wasting when height is also low. Another trap: assuming a low BMI alone defines severe malnutrition without considering edema or functional status. Beware attributing poor growth to psychosocial causes before excluding organic disease, and vice versa.
Worked example
A 14-month-old with weight-for-length below −3 SD, no edema, and poor intake after gastroenteritis: severe acute malnutrition (wasting). Start cautious refeeding, check electrolytes including phosphate, and monitor for refeeding syndrome.
Rule of thumb
Weight falls first in acute undernutrition; height falls later in chronic undernutrition. Always plot and trend, never rely on a single measurement.