Family and Nutri Assmnt

SEMINAR ON
FAMILY & NUTRITIONAL

ASSESSMENT IN
CHILDREN
Amy Lalringhluani
1st yr Msc Nursing
CPMS, Guwahati
FAMILY
ASSESSMENT
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 Family assessment
Family refers to two or more Family assessment is a process
individuals who depend on one of gaining a greater
another for emotional, understanding of how a
physical, and/or financial family's strengths, needs and
support. A social group resources affects a child's
characterized by common safety, permanency, and well-
residence, economic co- being.
operation and reproduction.
PURPOSE OF FAMILY ASSESSMENT
Gather important Assess and
Understand the
information evaluate condition Provide support
child’s needs
of child
Identify the needs

Identify help Offer support
of family
Assess if child’s Analyse the nature Support the family

needs are being and level of risks to build on
met facing the child strengths
Address problems to
Improve outcomes
assure the child’s
of child
safety
FEATURES OF 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
AREAS OF FAMILY ASSESMENT
Family, home
and
surrounding
neighborhood
Socioeconomic The family and Representing Patient and
Functions of family’s teaching
status and the social problem or
the family needs
religious system situation
Educational affiliation
background,
lifestyle and
beliefs of family
FAMILY ASSESSMENT TOOLS
Ecomap
of family
Genogram
GENOGRAM
A genogram is a graphic
representation of a family tree that
displays detailed data on
relationships among individuals
• Records names and roles of
Basic Genogram symbols
each member of the family
• Documents medical
problems of each of the
family
• Documents significant dates
in the family
Example of a Genogram
ECOMAP OF THE FAMILY
An ecomap illustrates the family`s
relationships and interactions with the
social network in the community
• Enables the nurse and other health care
providers to visualize the family`s social
network.
• Provides an opportunity to identify the
community resources being used by the
family
• Highlights any potential community
resources that may help promote the
family`s health
Ecomap of the family
BARRIERS TO SUCCESSFUL
ASSESSMENT
Poor focus
on child Fear &
Family
Disguised compliance imposed distrust of
ideas health care
Failure to system
balance
relationship
ROLE OF NURSE IN FAMILY
ASSESSMENT
Gather information relating to:
• The child’s developmental needs
• Parents or caregiver’s capacity to respond to those needs
• The impact of wider family and environmental factors
Seeing and Interviewing

interviewing the parents and/or
children caregivers
Coordinate the
Notes down the involvement of other
family interactions professionals
NUTRITIONAL
ASSESSMENT
INTRODUCTION
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 Nutritional assessment Nutritional Status
Nutrition is the intake of food, Nutritional assessment is It is status of a
considered in relation to the person related to
the interpretation of
body’s dietary needs. their state of
anthropometric,
• Good nutrition – an adequate, well nourishment (the
balanced diet combined with regular
biochemical (laboratory),
physical activity – is a cornerstone of clinical and dietary data to consumption and
good health. determine whether a person utilization of
• Poor nutrition can lead to reduced or groups of people are well nutrients).
immunity, increased susceptibility to nourished or malnourished
disease, impaired physical and mental
development, and reduced (over-nourished or under-
productivity. nourished).
ENERGY EXPENDITURE IN CHILDREN
ENERGY EXPENDITURE
Growth Thermogenesis Physical activity Basal Metabolism

2% 8% 25 % 65 %
PURPOSES OF NUTRITIONAL
ASSESSMENT
To identify individuals or population groups
at risk of becoming malnourished.
To obtain precise information about the
prevalence and geographic distribution of
nutritional problems of a community.
To develop health care programs that meet
the community needs.
To measure the effectiveness of the
nutritional programs and intervention once
initiated.
METHODS OF NUTRITIONAL
ASSESSMENT
INDIRECT A - Anthropometric
Methods
METHODS
B - Biochemical/
Ecological variables laboratory Methods
Economic factors C – Clinical Methods
D – Dietary Methods
Vital health statistics
Utilization of health DIRECT

care services METHODS
ANTHROPOMETRIC METHODS
Anthropometry is the science of body measurements. It is the measurement of
body height, weight & proportions
Anthropometric measurements Anthropometric measurements
used to assess growth used to assess body composition
 Weight  Skin fold thickness

 Height/Length  Mid upper arm circumference
 Head circumference  Body Mass Index
 Chest circumference
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.
In adults and children over

two years a beam balance is
used and the measurement is
also to the nearest 0.1 kg.
b)HEIGHT/LENGTH
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- Measuring Length in Children 0–2 Years of Age
2 cm.
Height
 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
Measuring Height in Children 2 Years of Age and
millimeter. Older, Adolescents, and Adults
c)HEAD CIRCUMFERENCE
Above ears  HC is measured to the nearest
Above
millimeter using flexible, non-
eyebrows Largest part of stretchable measuring tape around
back of head 0.6cm wide.
(Occipital
prominence)
 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
MEASURING HEAD CIRCUMFERENCE after two years the growth of the brain
is more sluggish and HC is not useful.
c)CHEST CIRCUMFERENCE
 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 MEASURING CHEST CIRCUMFERENCE
growth of brain is less affected by undernutrition.
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
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
MEASURING SKIN FOLD THICKNESS
b)MID UPPER ARM CIRCUMFERENCE
(MUAC)
MUAC is an accurate way to measure fat-free
mass
A low reading indicates a loss of muscle mass.
It is used for screening target children for severe
acute malnutrition and moderate acute
malnutrition. Measure at midpoint
Stand straight
during measurement
Measuring Mid-Upper Arm Circumference

c)BODY MASS INDEX
c)BODY MASS INDEX
Advantages & Limitations of Anthropometry
ADVANTAGES LIMITATIONS
₻ Objective with high specificity &
sensitivity
₻ Measures many variables of
₻ Inter-observers errors in measurement
nutritional significance (Ht, Wt, ₻ Limited nutritional diagnosis
MAC, HC, skin fold thickness and ₻ Problems with reference standards, i.e.
BMI).
₻ Readings are numerical & gradable local versus international standards.
₻ Arbitrary statistical cut-off levels for
on standard growth charts
₻ Readings are reproducible. what considered as abnormal values.
₻ Non-expensive and need minimal
training
BIOCHEMICAL/LAB METHODS
Specific Lab
Tests
Stool
examination
Urine dipstick
and
microscopy
Hemoglobin Radiological
estimation Studies
Advantages & Limitations of Biochemical Methods
ADVANTAGES LIMITATIONS
Useful in detecting early

Time consuming
changes in body metabolism
and nutrition Expensive
Precise, accurate and They cannot be applied
reproducible on large scale
Useful to validate data
Needs trained
obtained from dietary
personnel & facilities
methods
CLINICAL METHODS
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.
Detection of relevant signs helps in

establishing the nutritional
diagnosis
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.
CLINICAL SIGNS AND SYMPTOMS OF
NUTRITIONAL PROBLEMS
Organ Clinical findings Nutritional
deficiency
Mouth  Glossitis  Riboflavin, niacin,
folic acid, b12.
Leukoplakia
 Bleeding and  Vit c, a, k, folic acid
spongy gums and niacin.
 Angular stomatitis,  Vit b12 and vit b6.

cheilitis, and
fissured tongue.

 Leukoplakia.  Vit a, b12, folic acid,
Fissured tongue
& niacin.
PROBLEMS
Organ Clinical findings Nutritional
deficiency
Eyes  Night  Vitamin a
Exophthalmia blindness, deficiency.
Bitot’s spots,
exophthalmia.
Bitot’s spots
PROBLEMS
Organ Clinical findings Nutritional deficiency
Nails  Spooning  Iron deficiency. Spooning

 Transverse lines  Protein deficiency.
Skin  Pallor  Folic acid, iron, b 12.

 Follicular  Vit b and vit c. Follicular
hyperkeratosis. hyperkeratosis
 Flaking dermatitis.  PEM, vit b12, vit a,
zinc and niacin.
Flaking dermatitis
PROBLEMS
Organ Clinical Nutritional
findings deficiency
Thyroid  Goitre  Iodine
gland deficiency
Joints and  Rickets  Vit d
Goitre bones deficiency
.
 Scurvy  Vit c
deficiency
.
Rickets Scurvy
PROBLEMS
Faces of Malnutrition
Advantages & Limitations of Clinical Methods
 Fast and easy to

perform
 Inexpensive
 Non-invasive Limitations
Advantages
Does not detect early
cases
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.
24 hours Food
Dietary
dietary frequency
history since
recall questionnaire
early life
Observed
Food dairy
food
technique
consumption
Interpretation of dietary data
Qualitative Done using the food Quantitative Using food

pyramid and the basic
Method food group Method composition tables
Compared with
Compared with
minimum requirements. recommended daily
intake.
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
CONCLUSION

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SEMINAR ON

FAMILY & NUTRITIONAL

Identify the needs

Assess if child’s Analyse the nature Support the family

Seeing and Interviewing

Growth Thermogenesis Physical activity Basal Metabolism

Economic factors C – Clinical Methods

Utilization of health DIRECT

 Weight  Skin fold thickness

In adults and children over

 Measuring the child lying down

 The head should be in the Frankfurt position

 Either a stadiometer or a portable

 Children less than 5years are measured in lying down

 In normal children, after 1 year of age chest grows

 In malnourished children, chest size may be

Measuring Mid-Upper Arm Circumference

Useful in detecting early

Detection of relevant signs helps in

 Angular stomatitis,  Vit b12 and vit b6.

Nails  Spooning  Iron deficiency. Spooning

Skin  Pallor  Folic acid, iron, b 12.

 Fast and easy to

Qualitative Done using the food Quantitative Using food

Nutritional assessment in neonatal and prepubertal children with a

María Ortiz-Espejo, Juan Luís Pérez-Navero, María Carmen Muñoz-

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