Malnutrition

malnutrition Measure the following ǂ: Weight for height (<2yrs) Z-scores Body mass index-for-age (>2yrs) Z-scores Height for age Mid Upper Arm Circumference Z-scores Detailed history including food intake Careful physical exam Obtain all growth records Intake reduced Height and Head Circumference often preserved initially Decreased intake Non-organic causes/contributors Neglect* Decreased breast milk supply Inappropriate formula mixing Poverty Disturbed Parent-Child Relationship Disordered Eating* Oral aversion Organic causes Gastroesophageal Reflux/Reflux Disease* Neuromuscular disease with poor feeding Anatomical issues (e.g., Cleft lip, etc.) Dysphagia Intake Normal or High Height and Head Circumference often preserved initially Height and Head Circumference variable Height and Head Circumference often preserved initially Height may be reduced in endocrinopathies Height usually reduced Head circumference variable Increased Losses Vomiting* Gastroesophageal Reflux/Reflux Disease* Renal Tubular Acidosis Malabsorption (eg Celiac Disease*, Cystic Fibrosis*, Inflammatory Bowel Disease*, short bowel syndrome, infectious/post-infectious diarrhea) Failure to Utilize Metabolic Disease* Increased Demands Congestive Heart Failure* Chronic Respiratory Distress (eg Cystic Fibrosis*, chronic aspiration) Malignancy (eg Leukemia*) Endocrinopathies (eg Hyperthyroidism) Decreased growth potential Familial Short Stature* Genetic Syndromes (eg. Trisomy 21*, Turner Syndrome*) Intrauterine insults (eg. Congenital infections*, Fetal Alcohol Syndrome*)