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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