CPN CPE MMT cheat sheet

Anthropometric indices (weight-for-age, length/height-for-age, weight-for-length, BMI-for-age) are plotted on WHO Child Growth Standards for 0-5 years and CDC 2000 charts for ages 2-20 years; interpretation depends on which reference is used.

Z-score = (measured value − reference median) / reference SD; percent of median = (measured value / reference median) × 100. WHO defines wasting as weight-for-height Z < −2 and severe wasting as Z < −3.

Mid-upper arm circumference (MUAC) thresholds for children 6-59 months: <12.5 cm indicates severe acute malnutrition; 12.5-13.5 cm indicates moderate acute malnutrition (WHO/UNICEF).

Growth velocity is a more sensitive indicator than a single point: falling across two or more major percentile lines on weight-for-length or BMI-for-age suggests failure to thrive or acute undernutrition.

Head circumference is measured routinely until age 2-3 years; crossing percentile lines downward before 18 months warrants developmental and neurologic evaluation.

Dietary assessment methods: 24-hour recall (low burden, high recall bias), food frequency questionnaire (captures usual intake), weighed food record (most precise, high respondent burden), and direct observation in inpatient or daycare settings.

Laboratory markers of nutritional status include serum albumin and prealbumin (both influenced by inflammation, so not specific for malnutrition), retinol-binding protein for vitamin A, ferritin plus CRP for iron, and 25-hydroxyvitamin D for vitamin D.

Pediatric malnutrition screening tools include STAMP, STRONGkids, PYMS, and the Academy/ASPEN consensus criteria, which combine weight loss, inadequate intake, and subcutaneous fat or muscle loss.

Estimated energy requirements are highest per kilogram in infancy: approximately 100-120 kcal/kg/day at 0-6 months and 80-100 kcal/kg/day at 6-12 months, declining to roughly 30-40 kcal/kg/day by adolescence.

The 2020-2025 Dietary Guidelines and IOM equations estimate energy needs using age, sex, weight, height, and physical activity coefficient; catch-up growth adds roughly 5-10 kcal per gram of desired weight gain plus baseline needs.

Protein requirements decline with age: about 1.5 g/kg/day for infants 0-6 months, 1.2 g/kg/day for 7-12 months, 1.05 g/kg/day for 1-3 years, and 0.85-0.95 g/kg/day for older children and adolescents.

Fluid maintenance for children uses the Holliday-Segar method: 100 mL/kg/day for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 20 mL/kg/day for each kilogram above 20 kg.

Growth patterns: infants gain about 25-30 g/day in the first 3 months, double birth weight by 4-5 months, triple it by 12 months, and increase length by about 25 cm in the first year.

Fat intake should be about 45-55% of energy for infants 0-6 months, 40% for 6-12 months, and 30-35% for ages 1-3 years, with no restriction of fat before age 2.

Breast milk or iron-fortified formula is the sole source of nutrition until about 6 months; complementary foods begin around 6 months with iron-rich foods, and whole cow milk is delayed until 12 months.

Adolescent growth spurts occur around ages 10-11 in girls and 12-13 in boys; peak height velocity is roughly 9 cm/year in girls and 10.3 cm/year in boys.

In type 1 diabetes, medical nutrition therapy emphasizes matching carbohydrate intake to insulin, consistent meal timing, and individualized carbohydrate counting rather than fixed restriction.

In pediatric chronic kidney disease, protein and phosphorus are moderated, potassium and sodium are restricted as indicated by labs, and energy needs are often increased to support growth.

Cystic fibrosis nutrition targets 110-200% of estimated energy needs, high-fat intake, pancreatic enzyme replacement dosed per gram of dietary fat, and fat-soluble vitamin supplementation (A, D, E, K).

Inborn errors of metabolism: phenylketonuria requires a phenylalanine-restricted diet with a tyrosine-supplemented medical formula; galactosemia requires exclusion of galactose and lactose; maple syrup urine disease restricts branched-chain amino acids.

Pediatric obesity management uses intensive health behavior and lifestyle treatment (≥26 contact hours over 3-12 months) for children 6 years and older, with pharmacotherapy and metabolic surgery reserved for select adolescents.

Food allergy management centers on strict avoidance of the identified allergen, emergency action plans with epinephrine for anaphylaxis risk, and growth monitoring when multiple foods are eliminated.

Celiac disease requires a lifelong strict gluten-free diet with attention to iron, folate, calcium, and vitamin D adequacy; serology should normalize on adherence.

In pediatric oncology, energy and protein needs are increased during treatment; mucositis and nausea often require texture modification, small frequent meals, and enteral support when oral intake is inadequate.

Enteral nutrition is preferred over parenteral whenever the gastrointestinal tract is functional; the mantra is 'if the gut works, use it.'

Pediatric enteral formulas are classified as polymeric (intact protein, age ≥1 year), semi-elemental (hydrolyzed protein), and elemental (amino acid-based, for severe malabsorption or allergy).

Gastric feeding is preferred over post-pyloric feeding because it allows larger bolus volumes and more physiologic digestion; post-pyloric placement is used for gastroparesis, severe reflux, or aspiration risk.

Parenteral nutrition in children requires dextrose infusion rates limited to about 12-14 mg/kg/min in neonates to prevent hyperglycemia and hepatic steatosis; lipid emulsions provide essential fatty acids.

Pediatric PN is compounded with a pediatric trace element and multivitamin formulation; calcium and phosphate compatibility limits concentration, especially in small-volume neonatal bags.

Refeeding syndrome risk is highest in severely malnourished children; start at 10-20 kcal/kg/day, monitor potassium, magnesium, and phosphorus, and advance gradually over 4-7 days.

Enteral feeding complications include aspiration, diarrhea from formula osmolality or antibiotics, tube dislodgement, and refeeding syndrome; monitoring includes weights, intake/output, and electrolytes.

Cyclic or nocturnal tube feeding supports oral motor development and daytime hunger in children transitioning from tube to oral feeding.

The transtheoretical model stages are precontemplation, contemplation, preparation, action, and maintenance; interventions should match the family's current stage.

Motivational interviewing uses open-ended questions, affirmations, reflective listening, and summaries (OARS) to build intrinsic motivation rather than to advise or confront.

Ellyn Satter's division of responsibility assigns the parent responsibility for what, when, and where food is offered, and the child responsibility for whether and how much to eat.

Responsive feeding practices include recognizing hunger and satiety cues, avoiding pressure or forced feeding, and structuring regular meals and snacks rather than grazing.

Behavior change techniques with evidence in pediatric nutrition include goal setting, self-monitoring, stimulus control, and parent modeling of healthy eating.

Family-based treatment is the first-line approach for pediatric overweight and obesity; parental involvement and home environment change outperform child-only interventions.

Counseling must be developmentally tailored: play-based and sensory exploration for toddlers and preschoolers, concrete goal setting for school-age children, and autonomy-supportive approaches for adolescents.

Cultural humility and food security screening (for example, the Hunger Vital Sign two-item tool) shape realistic, respectful counseling plans.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental foods, nutrition education, and breastfeeding support to eligible pregnant and postpartum women and children up to age 5.

The National School Lunch Program and School Breakfast Program must meet USDA meal pattern standards for fruit, vegetables, grains, milk, and calorie and sodium limits by age group.

The Community Preventive Services Task Force recommends school-based nutrition education and improved access to healthy foods as evidence-based obesity prevention strategies.

The CDC growth chart surveillance and the WHO/UNICEF/World Bank joint malnutrition estimates provide population-level prevalence data for stunting, wasting, and overweight.

Breastfeeding promotion follows the Baby-Friendly Hospital Initiative Ten Steps, including early skin-to-skin contact, rooming-in, and avoiding pacifiers and artificial nipples for breastfeeding infants.

The Dietary Guidelines for Americans and the 2020-2025 edition apply from age 2 onward; infants under 2 have separate guidance emphasizing breastfeeding and nutrient-dense complementary foods.

Food insecurity screening in clinical and community settings uses validated tools and referral to federal programs including SNAP, WIC, and school meal programs.

Community nutrition interventions often use the social-ecological model, addressing individual, interpersonal, organizational, community, and policy levels simultaneously.

Registered dietitian nutritionists practice within the Scope and Standards of Practice of the Academy of Nutrition and Dietetics and maintain state licensure or certification where required.

The Code of Ethics for the Nutrition and Dietetics Profession obliges practitioners to place patient welfare first, maintain competence, respect confidentiality, and avoid conflicts of interest.

Informed consent for nutrition intervention requires disclosure of purpose, risks, benefits, and alternatives, with assent from minors and consent from parents or guardians.

HIPAA and FERPA govern privacy of health and educational records; school nutrition professionals must protect student information accordingly.

Documentation in the Nutrition Care Process uses the ADIME or SOAP format and includes assessment, diagnosis (PES statement), intervention, monitoring, and evaluation.

The Nutrition Care Process PES statement format is Problem (nutrition diagnosis) related to Etiology as evidenced by Signs and Symptoms.

Mandatory reporting laws require dietitians to report suspected child abuse or neglect, including severe malnutrition or medical neglect, to designated authorities.

Evidence-based practice integrates best available research, clinical expertise, and patient values; the Academy's Evidence Analysis Library is a key resource.