Table An Approach to the Identification of Nutritional Problems

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Routine: To be done on all patients. If problems are indicated, additional midlevel or in-depth parameters should be evaluated

Midlevel, add: As indicated by routine screening or in populations at risk for chronic nutrition problems and children with special health care needs

In-depth, add: As indicated in acute and chronic PCM and to monitor chronically ill patients

Typical dietary pattern (food pyramid/food frequency), vitamin and mineral supplement, family eating habits, subsidy support

24-hour recall and 3- to 7-day food records, developmental evaluation of feeding skills

Same, observation in hospital

Physical and dental history and examination, sexual maturation, use of medication(s)

More extensive examination (eg, skin, hair, nails)

Bone mineralization (eg, epiphyseal enlargement, cranial bossing), bone age

Weight, length, head circumference, weight for height, and BMI

Height and weight Z score, triceps skinfold, arm circumference, prediction of mature height

Height velocity

Hemoglobin, hematocrit, MCV, total cholesterol (LDL dependent on total cholesterol, see Table 29-2, page 436)

Albumin, total protein, total lymphocyte count

Specific vitamin, mineral, and electrolyte levels or enzymes and proteins that require that nutrient; delayed cutaneous hypersensitivity (see Table 4-2, pages 71-6)

BMI = body mass index; MCV = mean corpuscular volume; LDL = low-density lipoprotein; PCM = protein calorie malnutrition.

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