Other challenges include:
- Weight-for-height percentiles and body mass index may not be adequate to assess under-nourishment. [Fung: 2002]
- Standard measures of nutritional status, such as serum albumin and prealbumin, are not reliable in this population. Even in the face of severe chronic malnutrition, the majority of children with CP, for instance, maintain normal levels of serum albumin and prealbumin.
- Parents often over-record food intake when compared to actual measures of caloric intake.
- Linear growth can be difficult to assess when there are contractures, scoliosis, difficulty with standing, and/or lack of cooperation.
- Determining energy needs may be complicated in children with cerebral palsy or other chronic condition due to decreased physical activity and decreased caloric need in some children and increased caloric need due to the presence of spasticity, constipation, drooling, and/or excessive sweating in others.
- Measure weight and length/height consistently and watch for trends (weight gain, linear growth, weight loss trends with intercurrent illness).
- Measure fat stores if you have a skinfold caliper, or refer to a nutritionist.
- Perform segmental measurements (e.g., tibial length). Extrapolating segmental measures provides a reasonable estimate of height that can be plotted on a standard growth curve.
- If nutritional status is deemed optimal, but the child continues to have poor growth velocity, evaluate for growth hormone deficiency.
- Keep in mind that 10-25% weight for age is acceptable in nonambulatory children.
- Use condition-specific growth charts when available.
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|Content Last Updated:||12/2015|
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