Paeds
Interventions
Formula fed
- Check daily vol
- Check timing and vol of feeds
- Recipe and technique of formula
- Increase strength
- May need to add CHO or fat
Breastfed
- ensure adequate ml over 24h
- lactation consultant
- top up with EBM after feeds
- top up with fortified EBM
- increase strength of formula
- Pump to get an idea how much you're feeding
Protein requirements
Protein requirements
0-6m 1.43g/kg/day
7-12 m 1.60
1-3 y 1.08
4-8y 0.91
9-13 B 0.94, G 0.87
14-18 B 0.99 G 0.77
Energy requirements
>2 years
PAL
1.2= bed rest
1.4= very sedentary
1.6= light activity
1.8= moderate activity
2.0= heavy activity
2.2= vigorous activity
Females
25-36m 0.244 x wt - 0.130
3-9y 0.085 x wt + 2.033
10-18y 0.056 x wt + 2.898
Males
25-36m 0.249 x wt - 0.127
3-9 yr 0.095 x wt + 2.11
10-18 y 0.074 x wt + 2.754
<2 years
Day 1 40ckal/kg/day
Days 2 & 3 60ckal/kg/day
Day 4 80ckal/kg/day
Day 5-3m 100kcal/kg/day
4 m 90kcal/kg/day
5-24m 80-90ckal/kg/day
Malnutrition
Assess current & previous dietary intake against EER and EPR
MUAC 3m-5y can be indicative of severe mal
growth velocity Z scores (0-2 years)
% wt loss
Faltering growth
<37 weeks= Fenton growth chart
2-18 years
CDC chart (centre for disease control)
>2
3rd and 97th percentile charts for the same parameters
BMI- Z score charts
0-2 years
WHO growth charts
>37 weeks, 2nd and 98th percentile charts for wt for age, lth for age, head circumference for age
1. Crossing 2+ percentile bands (wt for age, ht for age) over 6 months
2. Growth persistently below 3rd percentile
3. Wt >2 percentiles below ht percentile
4. Wt for Ht <5th percentile
Fluid requirements ml/kg/day
<10d 125-150
0-3m 140-160
4-6m 130-155
7-12m 120-135
2y 115-125
children. 1000-1500ml/d
Adolescents 1600-1900ml/d
growth patterns
Length velocity
0-12mnths 25cm (1/2 cm per week)
12-13cm in 2nd year of life
1-4 years approx 9-7cm/yr
5-9yrs approx 6-7/5-6cm/yr
10-14 yrs M 4-8cm/yr F 6-3cm/yr
15-18 yrs M: 8-0.9cm/yr F 1.4-0.2cm/yr
wt velocity
0-4 mnths 190-210g/wk
5-6 mnths 100-120g/wk
7-9 mnths 75-80g/wk
9-12 mnths 60g/wk
1-4 yrs 2-2.5kg/yr
5-9 yrs 2.5-3kg/yr
10-14 yrs M= 4-6kg/yr F = 4-4.5kg/yr
15-18 yrs M = 4-5kg/ye F = 2kg/yr
catch up growth infants 120-150% of expected above
Anthro
Skin fold thickness
MUAC
- 3 months and > = severe mal if MUAC is <1.5cm
- Can assess fluid use or gain
- Correlates with bw and BMI
- CDC
Knee height
>2 years of age
Left hand side
knee and ankle 90 degree sitting/supine
Heel to condyle of femur, proximal to patella
Caucasian boys height = (2.22 x KN) + 40.54
Caucasian girls height = (2.15 x KN) + 43.21
A/American boys height = (2.18 x KN) + 39.60
A/American girls height = (2.02 x KN) + 46.59
Knee height: ht = (2.69 xKH)
Height >2 years old
Feet slightly apart, flat on floor, heels against wall
All dorsal touching the wall
Head facing forward, slight upward pressure either side of skull
record to last completed 0.1cm
Head circumference
Associated with brain growth
Record to last completed 0.1cm
Length
Board/mat with head and foot board
2 people (carer at head)
supine, all limbs straight, feet flat
Record to last completed 0.1cm
Weight
>2 years of age
Ensure they always wear the same clothing
Record to nearest 100g
<12 months old or <10kg
use baby scales
bare weight- all clothing and nappy removed
- Newborns: record to nearest 10g
- Infants: record to nearest 100g
