Pediatric Nutrition Assessment
Pediatric nutrition assessment asks whether a child’s growth, intake, and clinical status fit health - and if not, why. The exam tests your ability to select the right reference, interpret serial measurements, and separate acute from chronic nutrition problems.
Core framework
- Anthropometrics: weight, length/height, head circumference under 2 years, and mid-upper arm circumference for acute malnutrition. In the US, use WHO charts for 0–2 years and CDC charts for 2–20 years; record z-scores for young children and percentiles for older children.
- Biochemical: CBC, ferritin, 25-hydroxyvitamin D, and lead when risk factors exist. Albumin and prealbumin reflect inflammation and are not stand-alone nutrition markers.
- Clinical: GI symptoms, dysphagia, edema, skin, dental status, and developmental feeding skills.
- Dietary: 24-hour recall, food frequency, formula preparation, supplements, and appetite.
- Environmental: food insecurity, culture, access, and the parent-child feeding relationship.
Worked example
An 18-month-old born at 28 weeks has weight-for-age z = −2.1 and length-for-age z = −0.8. Correct for prematurity to 16 months, use length-based weight, and compare with prior points. Asymmetric growth suggests acute undernutrition; symmetric stunting suggests chronic undernutrition. The plan is a focused feeding history, energy-dense foods, and follow-up in 2–4 weeks - not an immediate label of failure to thrive.
Traps
Using the wrong chart; forgetting corrected age; calling obesity from weight alone; treating low albumin as malnutrition; ignoring edema, dental pain, or food insecurity.