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Nutritional assessment is the tool by which the nutritionist evaluates the patient for maintenance of normal growth and health, risk factors contributing to disease, and early detection and treatment of nutritional deficiencies and excesses. Comparison of an individual with an established norm provides a basis for objective recommendations and evaluation of nutrition therapy.12 Although much information has been published on the use on increasingly sophisticated techniques, clinical judgment and perceptive history taking remain important overall components of nutritional assessment/ In children, this includes family history, developmental assessment, medical history including growth history, and physical examination including anthropometry. Nutritional assessment in children has special significance because undernutrition is the single most important cause of growth retardation.4 Acute and chronic malnutrition remain common in hospitalized pediatric patients in the United States, underscoring the need for early detection and treatment of nutritional deficiency.5 In addition, in the United States, overnutrition in the pediatric population has risen significantly,6 and the association of obesity with chronic diseases in adulthood such as heart disease and diabetes is strong; thus, nutrition assessment is equally important for the early referral and treatment of nutrition excess.

A combination of anthropometric, biochemical, clinical, anil dietary information forms the basis of evaluation. As no one parameter is completely satisfactory with regard to sensitivity and specificity, various tests monitor different aspects of nutritional status in each category. Standards that are relevant to a specific population are important, as are appropriate techniques and equipment for measurement. Throughout this manual, guidelines are provided to help determine where to begin the assessment of an individual (Table I- I), what type of assessment is likely to yield valuable screening information. and how and when to proceed with more extensive and costly evaluation. An example of a worksheet for data collection and assessment 011 general pediatrics is included (Table 1-2).' Dietary insufficiency or excess generally precedes signs of biochemical, anthropometric, or clinical deficiency. and guidelines for dietary assessment are included in this chapter. The various indices of anthropometry, reference standards, techniques, interpretation, and classification of malnutrition are detailed in Chapter 2. Clinical evaluation is covered in Chapter 3. Biochemical parameters useful in nutritional assessment, are included in Chapter 4. This information provides guidelines related to basic nutritional assessment; recommendations for specific disease states and nutrition therapies are discussed throughout the manual. The following are excellent general reference sources for pediatric nutritional assessment: The Centers for Disease Control (Nutrition Division. Atlanta. Georgia) Anthropometric Software Package, which can be used to calculate height and weight percentile. Z score, and malnutrition category relative to the National Center for Health Statistics (NCHS) reference growth standards; the American Academy of Pediatrics Pediatric Nutrition Handbook;x and Quality Assurance Criteria for Pediatric Nutrition Conditions, prepared by Dietitians in Pediatric Practice Group and published by the American Dietetic Association. Chicago. Illinois.1'

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