Nutritional assessment is an important initial step in nursing care and preventive health care. It aids in identifying eating practices, misconceptions, and symptoms that can lead to nutritional problems and eating disorders, including obesity, anorexia nervosa, and bulimia nervosa. Because the nurse often has continued contact with the parents and child, the nurse can often influence dietary practices.
Establishing Weight
Weight measurement is plotted on a growth chart (see Appendix B). Weight usually remains within the same percentile from measurement to measurement. Sudden increases or decreases should be noted. Average weight and height increases for each age are summarized in Table 7-1.
| Age | Weight | Height |
|---|---|---|
| 0 to 6 months |
Average weekly gain 140–200 gm (5–7 oz)
Birth weight doubles by 4–6 months
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Average monthly gain 2.5 cm (1 in) |
| 6 to 18 months |
Average weekly gain 85–140 gm (3–5 oz)
Birth weight triples by 1 year
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Average monthly gain 1.25 cm (0.5 in) |
| 18 months to 3 years | Average yearly gain 2–3 kg (4.4–6.6 lb) | Height at 2 years approximately half of adult height |
| 1 to 2 years | Average gain 12 cm (4.8 in) | |
| 2 to 3 years | Average gain 6–8 cm (2.4–3.2 in) | |
| 3 to 6 years | Average yearly gain 1.8–2.7 kg (4–6 lb) | Yearly gain 6–8 cm (2.4–3.2 in) |
| 6 to 12 years | Average yearly gain 1.8–2.7 kg (4–6 lb) | Yearly gain 5 cm (2 in) |
| Girl, 10 to 14 years | Average gain 17.5 kg (38.5 lb) |
95% of adult height achieved by onset of menarche
Average gain 20.5 cm (8.2 in)
|
| Boy, 12 to 16 years | Average gain 23.7 kg (52.1 lb) |
95% of adult height achieved by 15 years
Average gain 27.5 cm (11 in)
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| Measurements Related to Weight | Significance of Findings |
|---|---|
| Weight | |
| Infants (1 to 12 Months) | |
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Undress completely (including diaper) and lay on a balance infant scale. Protect the scale surface with a cloth or paper liner and zero the scale with the liner before weighing the infant.
Place hand lightly above the infant for safety. If precise measurements are required, have a second nurse perform an independent measurement. If there is a difference between the two measurements, a third one should be performed. For reliability in making comparisons, it is important to use the same scale, at the same time of day, for subsequent weight measurements.
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Breastfed infants tend to display slower growth than bottle-fed infants, especially in the second half of the first year. |
| Clinical Alert | |
| Weight loss or failure to gain weight might be related to dehydration, acute infections, feeding disorders, malabsorption, chronic disease, neglect, excessive ingestion of apple and pear juices, thyroid disorders, ectodermal dysplasias, diabetes, anorexia nervosa, cocaine use by mother in prenatal period, fetal alcohol syndrome, tuberculosis, or acquired immune deficiency syndrome (AIDS). A loss of 10% on a growth chart is indicative of severe weight loss. Excessive weight gain might be related to chronic renal, pulmonary, or cardiovascular disorders or to endocrine dysfunction. Children who are 120% or more of ideal body weight for height and age are considered obese. | |
| Measurements Related to Weight | Significance of Findings |
|---|---|
| Toddlers and Preschoolers (12 Months to 6 Years) | |
| Undress, except for underpants, and weigh on a standing balance scale. (Children younger than 2 years are weighed on an infant or sitting scale unless they can stand well.) | |
| Older Children (6 Years and Older) | |
| Remove shoes. Weigh clothed, on a standing scale. | Clinical Alert |
| Marked weight loss is often an initial sign of Type I diabetes. A body weight of less than 85% of the expected norm in adolescents might signal anorexia nervosa, especially if bradycardia, cold intolerance, dry skin, brittle nails, body distortion, and preoccupation with food are present. Weight loss can also accompany amphetamine use or changes in living conditions (e.g., homelessness). |
| Measurements Related to Weight | Significance of Findings |
|---|---|
| BMI | |
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Body mass index (BMI) indicates body composition and is a valuable indicator of the degree of overweight or obesity and of underweight. BMI takes into account the child’s height and weight and can be calculated through the following formula:
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See Appendix B for BMI age charts. |
| Skinfold Thickness | |
| Skinfold thickness is a more reliable indicator of body fat than weight because the majority of fat is stored in subcutaneous tissues. Measurements, as indicators of body fat, must be treated cautiously as findings will vary with experience and familiarity of assessor with technique. To measure skinfold thickness, use calipers such as Lange calipers. The most common sites for measurement are triceps and subscapular regions. For triceps, have child flex arm 90 degrees at elbow and mark midpoint between acromion and olecranon on the posterior aspect of the arm. Gently grasp fold of child’s skin 1 cm (0.4 inch) above this midpoint. Gently pull fold away from muscle and continuing to hold, place caliper jaws over midpoint. Estimate reading to nearest 1.0 mm, 2 to 3 seconds after applying pressure. Take measurements until two agree within 1 mm. | Clinical Alert |
| Obesity might be indicated by skinfold thickness greater than or equal to 85% for triceps measurement (see Appendix B). | |
| Measurement of Height/Length | Significance of Findings |
|---|---|
| Infants/Toddlers (1 to 24 Months) | |
| Lay infant flat. Have parent hold infant’s head as the infant’s legs are extended and pushed gently toward the table. Measure the distance between marks made indicating heel tips (with toes pointing toward the deficiency, ceiling) and vertex of head. Do not use a cloth tape for measurement because it can stretch. If using a measuring board or tray, align the infant’s head against the top bar and ask the parent to secure the infant’s head there. Straighten the infant’s body and, while holding the feet in a vertical position, bring the footboard snugly up against the bottoms of the feet. |
Clinical Alert
Although short stature is usually genetically predetermined, it can also indicate chronic heart or renal disease, growth hormone deficiency, malnutrition, Kearns-Sayre syndrome, Turner’s syndrome, dwarfism, methadone exposure, or fetal alcohol syndrome.
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| Measurement of Height/Length | Significance of Findings |
|---|---|
| Use the same technique to obtain subsequent height measurements. | |
| Children (24 Months and Older) | |
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Have child, in stocking feet or bare feet, stand straight on a standard scale. Measure with the attached marker, to the nearest 0.1 cm (0.03 inch).
If a scale with a measuring bar is not available or if a child is afraid of standing on the scale’s base, have the child stand erect against a wall. Place a flat object, such as a clipboard, on the child’s head, at a right angle to the wall. Read the height at the point where the flat object touches the measuring tape or the wall-mounted unit (stadiometer).
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Height is usually less in the afternoon than in the morning. Correct for this tendency by placing slight upward pressure under the jaw. |
Assessment of nutrition, feeding, and eating practices requires sensitivity on the part of the nurse. Eating practices are highly personal, as well as cultural, and can be more accurately assessed after a rapport has been established. Guilt, apprehension, and the parent’s desire to give the “right” responses can alter the accuracy of the assessment. Table 7-2 lists typical eating habits for various age groups. Table 7-3 lists assessment findings that are associated with anorexia nervosa and bulimia nervosa, and Table 7-4 describes physical assessments and findings associated with nutrition.
| Age Group | Eating Practices | Concerns Arising from Eating Practices |
|---|---|---|
| Infants/toddlers (1 to 12 months) |
Formula or breast milk forms major part of diet for first 6 months and is generally recommended until 1 year.
Solid foods assume greater importance in second 6 months of life. By 1 year, infant is able to eat all solid foods unless food intolerance develops. White grape juice is a healthy form of juice. Juice intake should be limited to no more than 150 ml per day in infants.
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Mothers might feed child in accordance with practices followed in their own upbringing.
Early introduction of solid foods (before 5 or 6 months) can contribute to allergies.
Sensitivity to cow’s milk might be suggested by colic, sleeplessness, diarrhea, abdominal pain, chronic nasal discharge, recurrent respiratory ailments, eczema, pallor, or excessive crying.
Colic, regurgitation, diarrhea, constipation, bottle mouth syndrome, and rashes are common concerns associated with infant feeding.
Yellowish skin coloration might accompany persistent feeding of carrots.
Excess milk intake in later infancy might lead to milk anemia.
Excessive ingestion of pear and apple juices can be associated with failure to thrive, tooth decay, diarrhea, and obesity.
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