FAMILY

ASSESSMENT

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INTRODUCTION

Formulating an effective treatment plan for the family requires proper assessment of the
family’s structure and style. Family assessment is done to develop a deep understanding of
what family knows, understand and can do for their child’s future development. The values,
ideas, religious beliefs, traditions and goals of individuals and family may differ. So, the
nurse should understand the concept of culture and its impact on assessment. The assessment
should be strength-based, culturally sensitive, individualized, and developed in partnership
with the family. The strengths identified will provide the foundation upon which the family
can make change.

TERMINOLOGIES

Family

 The family is a social institution, which is the most fundamental to all social groups.
Family is a group of persons by the ties of marriage, blood, adoption, constituting a
single household, interacting and intercommunicating with each other in their
respective social roles of husband and wife, mother and father, son and daughter,
brother and sister creating a common culture.
[Burgess and Lacke]

 Family refers to two or more individuals who depend on one another for emotional,
physical, and/or financial support. A social group characterized by common
residence, economic co-operation and reproduction.
(Murdock GP)

Family assessment

Family assessment means a process of gaining a greater understanding of how a family's

strengths, needs and resources affect a child's safety, permanency, and well-being.
Comprehensive family assessment helps in identifying, gathering and weighing information
to understand the significant factors affecting a child’s safety, permanency, well-being, and
parental protective capacities and the family’s ability to assure the safety of child’s wellbeing.

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PURPOSE OF FAMILY ASSESSMENT

Good assessments must be purposeful and timely. Nurses need to be clear about why they are
carrying out assessments and what they wish to achieve. The various purposes of family
assessment are to:

1) Gather important information about a child and family’s health.

2) Understand the child’s needs
3) Decide whether the child is in need or is suffering, or likely to suffer from significant
harm.
4) Provide support to address those needs to improve the child’s outcomes to make them
safe.
5) Identify help to prevent a child’s needs becoming more serious.
6) Offer target support from universal services, family and parenting programmes
7) Identify the needs of family with multiple problems, methods of preventing them and
promoting their health e.g. help for substance abuse, domestic violence and/or mental
health problems
8) Assess whether child’s needs are being met by the family or by any other services
9) Analyse the nature and level of any risks facing the child
10) Support the family to build on strengths
11) Address problems to assure the child’s safety
12) Improve outcomes of child.

FEATURES OF HIGH QUALITY ASSESSMENT

The 2015 Working together to safeguard children (HM Government, 2015) guidance for
England listed some of the following as features of a high quality assessment:

 It is child-centered and informed by the views of the child

 Decisions are made in the best interests of the child
 It is built on strengths as well as identifying difficulties.
 It ensure equality of opportunity and a respect for diversity including family
structures, culture, religion and ethnic origin
 It is a continuing process, not a single event

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AREAS OF FAMILY ASSESMENT

 Family, home and surrounding neighborhood

 Educational background, lifestyle and beliefs of family
 Socioeconomic status and religious affiliation
 Functions of the family
 The family and the social system
 Representing problem or situation
 Patient and family’s teaching needs

1. Family, home and surrounding neighbourhood: It includes

√ Amount of space in home and yard.
√ Furnishing and utilities.
√ Age and sex of family members.
√ Size and type of family.
√ Occupation of family members.
√ Health status of family members.
√ Physical limitations that would affect the family member’s ability to help with
care needs.
√ The surrounding neighbourhood; proportionate no. of adults, youth and children.
√ Amount of time the family spends in neighbourhood outside home.
√ Day care facilities like adult clubs, youth organizations etc.

2. Educational background, lifestyle and beliefs of family: It includes

√ Educational level of family members.
√ Their attitude towards learning.
√ Basic literacy skills of family members.
√ Language barriers to communication.
√ Any folk medicine belief or food belief
√ Lifestyle and cultural background.
√ Normal dietary pattern of family.

3. Socioeconomic status and religious affiliation: It includes

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 √ Occupation of each family member.
√ Goals of parents for themselves and their children
√ Source of income
√ Religious background of family members
√ Religious observation and involvement

4. Functions of family: It includes

√ Communication of family members with each other
√ Decision making of family members
√ Experience of family members in handling crises
√ Family understands in handling current health problem
√ Major problems the illness has caused for family
√ Fear about the situation
√ Their thinking about the treatment if any family member received.

5. The family as the social system: It includes

√ Children’s attitude towards parents and siblings
√ Response of each child to other family members
√ Responses of children to discipline.

6. Representing problem or situation: It includes

√ Attitudes of parents and children towards health care
√ Reaction towards treatment.

7. Patient and family’s teaching needs: It includes

√ Patients and families agreement with teaching plan
√ Physical or cognitive limitation that will be barrier to learning
√ Patients and families willingness to negotiate goals with health care team

FAMILY ASSESSMENT TOOLS

Family assessment tools can be used to gather additional information about the family`s
functioning and can place strengths. Information about the way the family functions in

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nurturing its members, problem solving and potentially more effective for management of
child’s health care. They enable the nurse to work more effectively, such as collaborating
with the family in planning for health maintenance and health promotion.

The assessment tools are

1. Genogram
2. Ecomap of family

GENOGRAM

A genogram is a graphic representation of a family tree that displays detailed data on

relationships among individuals

 A genogram is used most often to focus on the health history of a family, although
additional identifying features such as social class, occupation, place of residence,
religion and ethnicity may be added for the family assessment process.
 It is an excellent tool in learning about family structure
 Records names and roles of each member of the family
 Documents medical problems of each of the family
 Documents significant dates in the family

Fig: Basic Genogram symbols

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 Fig: Example of a Genogram

A genogram is used most often to focus on the health history of a family, although additional
identifying features such as social class, occupation, place of residence, religion and ethnicity
may be added for the family assessment process.

ECOMAP OF THE FAMILY

An ecomap illustrates the family`s relationships and interactions with the social network in
the community, enabling the nurse and other health care providers to visualize the family`s
social network. The ecomap provides an opportunity to identify the community resources
being used by the family and to highlight any potential community resources that may help
promote the family`s health.

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BARRIERS TO SUCCESSFUL ASSESSMENT

1. Focusing on the child is an essential ingredient of effective assessments. However, in

practice, it’s very difficult to focus on child because on one side nurse has to focus on
needs of the child and on the other side; the nurse has to build an effective
relationships with the family members, as the cooperation of parents is vital in
successful assessment.
2. A delicate balance needs to be struck to avoid neglecting relationships with parents;
becoming too involved with needy adults or getting so caught up in a family’s chaotic
situation diverts away attention from the child
3. Nurses can also meet with ‘disguised compliance’ from adults who appear to be co-
operative but are not. Such adults change the statements and provide the doubtful
responses
4. Family imposed ideas like “it’s not good to educate girls”.
5. Fear and distrust of health care system.

ROLE OF NURSE IN FAMILY ASSESSMENT

1. During the family assessment, the role of nurse is to gather information relating to:
a) The child’s developmental needs:
- It covers self-care skills, social presentation, family and social
relationships, identity emotional and behavioural development,
education and health.
b) Parents or caregiver’s capacity to respond to those needs:
- The specific components of parenting capacity are basic care, ensuring
safety, emotional warmth, stimulation, guidance and boundaries and
stability.
c) The impact of wider family and environmental factors on both the child’s
development and parenting capacity specifically:
- Community resources
- The family’s social integration
- Income
- Employment
- Housing

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 - Family history and functioning.
2. Seeing and interviewing the children:
- Professional nurses should make every effort to see the child on their own.
- The interviews should minimize distress for the child and enable them to open
up.
- Nurses must avoid asking leading or suggestive questions.
- They also need to spend time building a relationship, listening to and
respecting the child’s views, explaining the assessment process, and enabling
them to make choices where possible.
3. Interviewing parents and/or caregivers individually:
- Whole family assessments and observations of parent- child interaction in a
number of settings must be implemented at different times of the day.
- The relationships between parents and each child in the family should be
considered individually, as parents may be able to provide adequate care for
one child but not for another.
- It is important not to ignore the role and influence of fathers within the family,
even if they are not currently living with their children.
- Assessments also need to construct a family history, particularly any previous
involvement with social services and the outcomes of this involvement for the
child.

4. Nurse notes down, how the family interacts with her and with each other.
- She becomes vigilant to find out signs of family disunity, poor
communication, inflexibility, and animosity between the adults .As these
features of family functioning are strong indicators of a number of different
types of child maltreatment

5. Nurse has to coordinate the involvement of other professionals in the process like
speech and language therapists, child psychologists and drug and alcohol counsellors
etc.

9
NUTRITIONAL
ASSESSMENT

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INTRODUCTION

Nutrition is a critical part of health and development. Better nutrition gives way to

- improve infant, child and maternal health

- stronger immune systems
- safer pregnancy and childbirth
- lower risk of non-communicable diseases

Healthy children learn better. People with adequate nutrition are more productive and can
create opportunities to gradually break the cycles of poverty and hunger. Malnutrition in any
form presents significant threats to human health. Today the world faces a double burden of
malnutrition that includes both under nutrition and overweight, especially in low- and
middle-income countries.

TERMINOLOGIES

Nutrition:

Nutrition is the intake of food, considered in relation to the body’s dietary needs. Good
nutrition – an adequate, well balanced diet combined with regular physical activity – is a
cornerstone of good health. Poor nutrition can lead to reduced immunity, increased
susceptibility to disease, impaired physical and mental development, and reduced
productivity.

Nutritional assessment:

Nutritional assessment is the interpretation of anthropometric, biochemical (laboratory),

clinical and dietary data to determine whether a person or groups of people are well
nourished or malnourished (over-nourished or under-nourished).

Nutritional Status:

It is status of a person related to their state of nourishment (the consumption and utilization of
nutrients).

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ENERGY EXPENDITURE IN CHILDREN

Energy expenditure is the amount of energy that a person needs to carry out physical
functions such as breathing, circulating blood, digesting food, or exercising. Energy is
measured in calories, and the total daily energy expenditure (TDEE) is the number of calories
burnt each day. The child’s energy expenditure each day is distributed as follows:

a. Growth (quantitative process of increase in size) - 2 %

b. Thermogenesis (necessary for digestive and metabolic utilization of nutrients) - 8 %
c. Physical activity (Energy for muscle contraction and movements) - 25 %
d. Basal Metabolism (energy needed to maintain essential physiological functions)-65 %

PURPOSES OF NUTRITIONAL ASSESSMENT

1. To identify individuals or population groups at risk of becoming malnourished.

2. To obtain precise information about the prevalence and geographic distribution of
nutritional problems of a community.
3. To develop health care programs that meet the community needs.
4. To measure the effectiveness of the nutritional programs and intervention once
initiated.

METHODS OF NUTRITIONAL ASSESSMENT

Nutrition is assessed by two methods

1. Indirect Method
2. Direct method

The direct methods deal with the individual and measure objective criteria, while indirect
methods use community indices that reflect the community nutritional status/needs.

A. INDIRECT METHODS

It uses community health indices that reflect nutritional influences. The different types of
indirect methods are as follows;

1. Ecological variables: including agricultural crops production.

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 2. Economic factors: E.g , household income, per capita income, population density ,
food availability and prices , cultural and social habits.
3. Vital health statistics: Morbidity, mortality and other health indicators , e.g infant and
under-five mortality.
4. Utilization of maternal and child health care services, fertility indices and sanitary
conditions.

B. DIRECT METHODS

The direct methods are summarized as HABCD

 A – Anthropometric Methods
 B – Biochemical, laboratory Methods
 C – Clinical Methods
 D – Dietary Methods

1. Anthropometric Methods

Anthropometry is the science of body measurements. It is the measurement of body height,

weight & proportions. It is an essential component of clinical examination of infants,
children, and pregnant women. These measurements are compared to the reference data
(standards) of the same age and sex group in order to evaluate the current nutritional status. It
is used to evaluate both under and over nutrition.

Anthropometry is the simplest and most practical tool. It includes measurement of:

Anthropometric measurements used Anthropometric measurements used

to assess growth to assess body composition
 Weight  Skin fold thickness
 Height/Length  Mid upper arm circumference
 Head circumference  Body Mass Index
 Chest circumference

A. ANTHROPOMETRIC MEASUREMENTS USED TO ASSESS GROWTH

a) WEIGHT
- A weighing sling (spring balance), also called the ‘Salter Scale’ is used for
measuring the weight of children under two years old, to the nearest 0.1 kg.

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- In adults and children over two years a beam balance is used and the
measurement is also to the nearest 0.1 kg.
- In both cases a digital electronic scale can be used if you have one available.
- Do not forget to re-adjust the scale to zero before each weighing. You also need
to check whether your scale is measuring correctly by weighing an object of
known weight.
- Weight is an important parameter and the expected weight for different age
groups are calculated as follows:

Age Group Formula

3-12mon Expected wt = Age in months + (9/2)
1-6 years Expected wt= (Age in Years × 2)+8
7-12 years Expected wt=(Age in years × 7) - 5/2
2-12 years Expected wt=(Age in months+3) × 5/2

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 Fig: Measuring child’s weight using the Salter Scale
b) HEIGHT/LENGTH
- Height for age is useful for malnutrition spread over a prolonged period (chronic
malnutrition). Since change in height occurs only gradually compared to weight,
early detection of malnutrition or diagnosis of acute malnutrition is not workable
by this parameter
Length:
 A wooden measuring board (also called sliding board) is used for
measuring the length of children under two years old to the nearest
millimeter
 Measuring the child lying down always gives readings greater than the
child’s actual height by 1-2 cm.

Fig: Measuring length

Height

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  This is measured with the child or adult in a standing position (usually
children who are two years old or more).
 The head should be in the Frankfurt position (a position where the line
passing from the external ear hole to the lower eye lid is parallel to the
floor) during measurement, and the shoulders, buttocks and the heels
should touch the vertical stand.
 Either a stadiometer or a portable anthropometer can be used for
measuring. Measurements are recorded to the nearest millimeter.

Fig: Measuring height

c) HEAD CIRCUMFERENCE
- The head circumference (HC) is the measurement of the head along the supra
orbital ridge (forehead) anteriorly and occipital prominence (the prominent area
on the back part of the head) posteriorly.
- It is measured to the nearest millimeter using flexible, non-stretchable measuring
tape around 0.6cm wide.

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 - HC is useful in assessing chronic nutritional problems in children under two
years old as the brain grows faster during the first two years of life. But after two
years the growth of the brain is more sluggish and HC is not useful.
- Intrauterine growth retardation or extreme chronic malnutrition children will
have less HC.

Fig: Measuring Head Circumference

c) CHEST CIRCUMFERENCE
- Chest circumference or thoracic diameter is an important parameter assessment
of growth and nutrition status.
- Chest circumference is measured by placing the tape at level, around the nipple,
in between inspiration and expiration.
- Children less than 5years are measured in lying down position and children
above 5 years in standing position.
- In normal children, after 1 year of age chest grows more rapidly compared to the
brain.
- In malnourished children, chest size may be significantly smaller than head
circumference because growth of brain is less affected by undernutrition.
Therefore there will be considerable delay before chest circumference overtakes
head circumference.

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 Fig: Measuring chest circumference

B. ANTHROPOMETRIC MEASUREMENTS USED TO ASSESS BODY

COMPOSITION

a) SKIN FOLD THICKNESS

- Skin fold thickness indicates the status of fat deposits in the body
- It is measured at biceps, triceps, intrascapular and suprailiac regions
- Skin fold thickness is measured with Herpenden’s caliper
- The skinfold with subcutaneous fat is picked up with thumb and index finger,
and caliper is applied beyond the pinch.
- Not recommended in obese individuals as it will yield faulty results
- Pressure should be maintained 10g/mm2
- Fat thickness more than 10mm in 1-6 years indicates healthy children.
- Fat thickness less than 6mm is indicative of moderate to severe degree of
malnutrition

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 Fig: Measuring skin fold thickness Fig: Herpenden’s caliper

b) MID UPPER ARM CIRCUMFERENCE (MUAC)

- MUAC is an accurate way to measure fat-free mass
- The MUAC is the circumference of the upper arm at the midway between the
shoulder tip and the elbow tip on the left arm.

Fig: Measuring MUAC

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 - The mid-arm point is determined by measuring the distance from the shoulder
tip to the elbow and dividing it by two.
- A low reading indicates a loss of muscle mass.
- It is used for screening target children for severe acute malnutrition and
moderate acute malnutrition.

Methods used to measure MUAC:

1. Bangle test
 Quick assessment of arm circumference.
 A fiber glass ring of internal diameter of 4 cm is slipped up the arm, if it
passes above the elbow, it suggests that upper arm is less than 12.5 cm
and child is malnourished.
2. Shakir tape
 Is a fiber-glass tape with
 Red shading – less than 12.5 cm
 Yellow shading – 12.5- 13.5 cm
 Green shading – greater than 13.5 cm shading
3. QUAC stick – Quaker Upper Arm Circumference Stick
 It is developed on the principle that acute starvation severely affects mid-
arm circumference while height is unaffected.
 It is a height measuring rod, calibrated in MAC.
 Values of 80% MAC for Ht. are marked on stick at corresponding ht.
levels
 The malnourished child would be taller than the anticipated height derived
from the mid-arm circumference MAC (cm).

Cut-off points for screening

Target Groups MUAC (in cm) Malnutrition

Children under five 12.5 -13.5 cm Moderate acute malnutrition
< 12.5 cm Severe acute malnutrition

c) BODY MASS INDEX

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- Body Mass Index (BMI) is an anthropometric index with a unit of (kg/m2) that
is the measure of weight in kilograms adjusted for height in meter square. Being
a simple, noninvasive and inexpensive method, it is considered as a surrogate
measure of direct body measurements including body fat.
-
weight ∈kg
BMI =
height∈m 2

- High values of BMI indicate morbidity and risk to obesity in both children and
adults.
- BMI for children and adolescents between 2 to 20 years is age and gender
specific considering the increasing fat stores in the body.
- BMI is not a diagnostic tool but is accurately used to screen underweight or
overweight children
- For children and teens, BMI age- and sex-specific percentiles are used for two
reasons:
i. The amount of body fat changes with age.
ii. The amount of body fat differs between girls and boys.

BMI for-age categories with their respective percentiles are based on the World
Health Organization Recommendations

Weight status Percentile Ranking

Underweight Less than 5th percentile
Healthy weight 5th percentile to less than 85th percentile
Overweight 85th percentile to less than 95th percentile
Obese Equal to or greater than the 95th percentile

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 Fig: Example of how sample BMI numbers would be interpreted for a 10-year-old boy

ADVANTAGES OF ANTHROPOMETRY

 Objective with high specificity & sensitivity

 Measures many variables of nutritional significance (Ht, Wt, MAC, HC, skin fold
thickness and BMI).
 Readings are numerical & gradable on standard growth charts
 Readings are reproducible.
 Non-expensive and need minimal training

LIMITATIONS OF ANTHROPOMETRY

 Inter-observers errors in measurement

 Limited nutritional diagnosis
 Problems with reference standards, i.e. local versus international standards.
 Arbitrary statistical cut-off levels for what considered as abnormal values.

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 2. Biochemical/Laboratory Methods

Laboratory tests based on blood and urine can be important indicators of nutritional status,
but they are influenced by non-nutritional factors as well. It involves measurement of nutrient
levels or their metabolites in body tissues or fluids. Lab results can be altered by medications,
hydration status, and disease states or other metabolic processes, such as stress. As with the
other areas of nutrition assessment, biochemical data need to be viewed as a part of the
whole.

1. Hemoglobin estimation
 It is the most important test and useful index of the overall state of nutrition.
 Beside anemia it also tells about protein & trace element nutrition.
2. Stool examination
 It is done for the presence of ova and/or intestinal parasites
 History of parasitic infestation, chronic dysentery and diarrhea provides useful
background information about the nutritional status of person
3. Urine dipstick and microscopy
 It is done to detect any albumin, sugar and blood in urine
4. Specific Lab Tests
 Measurement of individual nutrient in body fluids (e.g. serum retinol, serum iron,
urinary iodine, vitamin D)
 Detection of abnormal amount of metabolites in the urine (e.g. urinary creatinine/
hydroxyproline ratio which is useful in studying physiological variation in growth
over short periods of time).
 Analysis of hair, nails and skin for micro-nutrients.
5. Radiological Studies
 X- ray and scans maybe done to detect any abnormalities in the skeletal structure
that results from nutrient deficiencies.
 In rickets, there is healed concave line of increased density at distal ends of long
bones usually the radius and ulna.
 In infantile scurvy there is ground glass appearance of long bones with loss of
density.
 In beriberi there is increased cardiac size as visible through X-rays.

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ADVANTAGES OF BIOCHEMICAL METHODS

 It is useful in detecting early changes in body metabolism and nutrition before the
appearance of overt clinical signs.
 It is precise, accurate and reproducible.
 Useful to validate data obtained from dietary methods e.g. comparing salt intake with
24-hour urinary excretion.

LIMITATIONS OF BIOCHEMICAL METHODS

 Time consuming
 Expensive
 They cannot be applied on large scale
 Needs trained personnel & facilities

3. Clinical Methods

It is an essential feature of all nutritional surveys. It is the simplest and most practical method
of ascertaining the nutritional status of a group of individuals. It utilizes a number of physical
signs, (specific and nonspecific), that are known to be associated with malnutrition and
deficiency of vitamins and micronutrients.

 Good nutritional history should be obtained

 General clinical examination, with special attention to organs like hair, angles of the
mouth, gums, nails, skin, eyes, tongue, muscles, bones and thyroid gland.
 Detection of relevant signs helps in establishing the nutritional diagnosis
 Clinical methods of assessing nutritional status involve checking signs of deficiency at
specific places on the body or asking the patient whether they have any symptoms that
might suggest nutrient deficiency from the patient.
 Clinical signs of nutrient deficiency include: pallor (on the palm of the hand or the
conjunctiva of the eye), Bitot’s spots on the eyes, pitting edema, goitre and severe visible
wasting.

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CLINICAL SIGNS AND SYMPTOMS OF NUTRITIONAL PROBLEMS:

Organ Clinical findings Nutritional deficiency

Hair  Sparse and thin.  Protein, zinc, biotin
deficiency.
 Easy to pull out  Protein deficiency

 Corkscrew coiled hair  Vit c and vit a

deficiency.
Mouth  Glossitis  Riboflavin, niacin,
folic acid, b12.
 Bleeding and spongy  Vit c, a, k, folic acid
gums and niacin.
 Angular stomatitis,  Vit b12 and vit b6.
cheilitis, and fissured
tongue.
 Leukoplakia.
 Vit a, b12, folic acid,
 Sore mouth and & niacin.
tongue.  Vit b12, b6, niacin, folic
acid and iron.
Eyes  Night blindness,  Vitamin a deficiency.
Bitot’s spots ,  Vit b, vit a
exophthalmia. deficiencies.
 Photophobia-
blurring, conjunctival
inflammation.
Nails  Spooning  Iron deficiency.
 Transverse lines  Protein deficiency.
Skin  Pallor  Folic acid, iron, b 12.

 Follicular  Vit b and vit c.

hyperkeratosis.
 Flaking dermatitis.  PEM, vit b12, vit a,
zinc and niacin.
 Pigmentation,  Niacin and PEM.
desquamation.
 Bruising, purpura.  Vit k, vit c, & folic
acid.
Thyroid gland  Goitre  Iodine deficiency
Joints and bones  Rickets  Vit d deficiency.
 Scurvy  Vit c deficiency.

ADVANTAGES

 Fast and easy to perform

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  Inexpensive
 Non-invasive

LIMITATIONS

 Does not detect early cases

4. Dietary Methods

Dietary methods of assessment include looking at past or current intakes of nutrients from
food by individuals or a group to determine their nutritional status.

Nutritional intake of humans is assessed by five different methods. These are:

 24 hours dietary recall

 Food frequency questionnaire
 Dietary history since early life
 Food dairy technique
 Observed food consumption

1. 24 hours dietary recall

 A trained interviewer asks the subject to recall all food and drink taken in the
previous 24 hours.
 It is quick, easy, and depends on short-term memory, but may not be truly
representative of the person’s usual intake

2. Food frequency questionnaire

 In this method the subject is given a list of around 100 food items to indicate his
or her intake (frequency and quantity) per day, per week and per month.
 It is inexpensive, more representative and easy to use.
 Limitations:
- Long Questionnaire
- Errors with estimating serving size.
- Needs updating with new commercial food products to keep pace with
changing dietary habits.

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3. Dietary history
 It is an accurate method for assessing the nutritional status.
 The information should be collected by a trained interviewer.
 Details about usual intake, types, amount, frequency and timing needs to be
obtained.
 Cross-checking to verify data is important.

4. Food dairy
 Food intake (types and amounts) should be recorded by the subject at the time of
consumption.
 The length of the collection period range between 1- 7 days.
 Reliable but difficult to maintain

5. Observed food consumption

 The most unused method in clinical practice, but it is recommended for research
purposes.
 The meal eaten by the individual is weighed and contents are exactly calculated.
 The method is characterized by having a high degree of accuracy but expensive
and needs time and efforts.

INTERPRETATION OF DIETARY DATA

1. Qualitative Method
 It can be done using the food pyramid and the basic food group method. Different
nutrients are classified into 5 groups (fat and oils, bread and cereals, milk
products, meat-fish-poultry, vegetables and fruits).
 The number of servings from each group is determined and is compared with
minimum requirements.
2. Quantitative Method
 The amount of energy and specific nutrients in each food consumed is calculated
using food composition tables and then is compared with the recommended daily
intake.
 Evaluation by this method is expensive and time consuming, unless computing
facilities are available.

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Sample Pediatric Nutritional Assessment Form

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CONCLUSION

Appropriate and sensitive assessment is important as the information collected by nurse

serves as the foundation for the development of client specific plans. Every step of working
with family requires a thoughtful, deliberate clinical reasoning process. Family assessment is
more than simple medical care for the child with health issues. When the nurse meets the
family, it is important to investigate how all members of family are affected by child’s health
issue.

A nutritional assessment is an in depth evaluation of both objective and subjective data

related to an individual’s food and nutrient intake, lifestyle, and medical history.

As a Nurse -

 Avoid Negligence
 Have sound knowledge and skill in assessment
 Have confidence in interpretation

As a human -

Fight against inequity

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 JOURNAL ABSTRACT

Nutritional assessment in neonatal and prepubertal children with a history of

extrauterine growth restriction

María Ortiz-Espejo, Juan Luís Pérez-Navero, María Carmen Muñoz-Villanueva, Gil-Campos

Mercedes

PMID: 23827379 DOI: 10.1016/j.earlhumdev.2013.06.003

Abstract

Background: Nutritional deficit during perinatal stage may induce significant alterations in
adipose tissue and increase the risk of obesity, metabolic syndrome and cardiovascular
disease in children with a history of extrauterine growth restriction (EUGR).

Aims: To describe the nutritional status in neonatal and prepubertal with a history of EUGR
and establish an association between EUGR and later conditions.

Study design: Descriptive, analytical, observational case-control study.

Subjects: The study included a sample of 38 prepubertal children with a history of EUGR,
and 123 gender-and-age matched controls.

Outcome measures: The EUGR group was asked to answer a food frequency questionnaire.
Analysis of body composition in both groups included anthropometric measurements,
assessment of blood pressure and biochemical markers.

Results: Newborns with EUGR received parenteral feeding with a standard nutritional regime
and long-chain fatty acid support for 41 ± 23 days; enteral feeding with a special formula for
premature infants was initiated at 7 ± 11 days of life. At the prepubertal stage, daily fiber and
fatty acid intake in children who had experienced EUGR in the neonatal stage was below the
recommended intake. In the EUGR group, the intake of vegetables, fruits and olive oil was
below dietary recommendations, while the intake of butchery, fatty meats, pastries and
snacks was above the recommendations for the Spanish population.

Conclusions: Appropriate nutrition education strategies should be developed for children with
a history of EUGR to prevent later associated pathologies, as neonatal nutritional support and
feeding during childhood are associated with an increase in diseases in this risk group.

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Journal Reference:

1. Ortiz-Espejo, M., Pérez-Navero, J. L., Muñoz-Villanueva, M. C., & Mercedes, G. C.

(2013). Nutritional assessment in neonatal and prepubertal children with a history of
extrauterine growth restriction. Early human development, 89(9), 763–768.
https://doi.org/10.1016/j.earlhumdev.2013.06.003

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