SBH Outpatient Nutrition Services / Pediatrics

Romilda Grella, MS, RD, CDNOutpatient Registered Dietitian

St. Barnabas Hospital - Ambulatory Clinic4487 Third Avenue, Bronx, NY 10457-2594

Tel: 1-718-960-5007 Pager: 1-877-714-4681 or **807Email: rgrella@stbarnabas-ny.org

The goal of nutrition management of children

• support optimal growth and development

• encourage physical activity and fitness

• ensure the availability of adequate nutrient stores for growth demands

• establish healthful eating habits that will lower the risk of chronic disease.

Pediatric Patients are referred to Nutrition Services by the Pediatrician.

Based on:

• History of poor or inadequate intake• Weight/Height <10th %ile• Overweight >85th %ile• Obese >95th %ile• Multiple food allergies/intolerances• Known food/drug interaction• Following special diets • Have risk factor including obesity related medial conditions such as hyperlipidemia,

hyperinsulinemia and high blood pressure.• Positive risk factors for type 2 diabetes, insulin resistance, cardiovascular disease risk factors.• Limited access to food• Food, nutrition related knowledge deficit• Physical inactivity• Dental carries

Initial Pediatric Nutritional Assessment

Subjective: Appetite % meals consumed GI distress Weight history Medications/vitamins Food Allergies/food intolerances Food Preferences Food recall (breakfast, lunch, dinner & snack)

Initial Pediatric Nutritional Assessment

Objective:

• Diagnosis• Past Medical History• Height• Height/age %ile• Weight• Weight/age %ile• Labs• Medications• Nutrition Assessment Flowsheet

Initial Pediatric Nutritional Assessment

Assessment:• Assessment of nutritional risk level • Diet tolerated• Weight status• Nutritional status• Estimated caloric needs• Estimated protein needs

Initial Pediatric Nutritional Assessment

Plan:• Goals• Recommendations• Follow up• Referral to other services

Growth Chart Boys 2-20 yrs, Weight (2000)

Growth Chart Boys 2-20 yrs, Height (2000)

BMI 2-20 years with 85th percentile

Growth Chart Girls 2-20 yrs, Weight (2000)

Growth Chart Girls 2-20 yrs, Height (2000)

BMI 2-20 years with 85th percentile

Adapted from http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf

SBH Nutrition Services Department Standards of Care

for Pediatric

Calculate estimated needs appropriate for age.

• Plot patient on growth chart weight for age at the 50th %

• Using the weight from the 50th % (kg) multiply by the age appropriate standards of care to determine patients estimated caloric and protein needs

Estimated Caloric Needs:• ____ based on ____Kcal/kg for age @ ( ___Kg 50th%ile wt

for age NCHS)Estimated Protein Needs:• ____ based on ___ gm/kg/day for age @ ( ___Kg 50th%ile

wt for age NCHS)

Example: 15 yr F, wt: 288 lbs (130.6 kg), ht: 62 in (157 cm), BMI: 52.9

• Using the female growth chart, look up wt at 50th %ile wt for age, 15 yr.

Estimated Caloric Needs:• 2132 based on 40 Kcal/kg for age @(53.3 Kg 50th%ile wt for age NCHS)Estimated Protein Needs:• 43 based on 0.8 gm/kg/day for age @(53.3 Kg 50th%ile wt for age NCHS)

• Growth percentile: >97th• Wt/age %ile weight/age percentile: >97th

• Ht/age %ile height/age percentile: <25th

• 50th %ile, weight for age 50th percentile wt for age: 53.3 kg• 50th %ile, height for age 50th percentile wt for age: 162.2 cm• % BMI: >97th

• Reinforcing the Childs ability to self-manage his or her own food intake in an important component of successful life long weight management.

Websites

• www.choosemyplate.gov• www.fns.usda.gov• www.kidshealth.org• www.KidsEatRight.org• www.eatsmart.org• www.letsmove.org• www.nourishinteractive.com