ASSESSMENT OF NUTRITIONAL STATUS OF INFANTS

1. NUTRITIONAL STATUS OF INFANTS
NUTRITIONAL STATUS- NUTRITIONAL STATUS IS THE CURRENT
BODY STATUS, OF A PERSON OR A POPULATION GROUP, RELATED
TO THEIR STATE OF NOURISHMENT (THE CONSUMPTION AND
UTILIZATION OF NUTRIENTS).

2. Purpose of nutritional assessment
• Identify individuals or population groups at risk of becoming
malnourished
• Identify individuals or population groups who are malnourished
• To develop health care programs that meet the community
needs which are defined by the assessment
• To measure the effectiveness of the nutritional programs &
interventions once initiated

3. Direct Methods of Nutritional Assessment
I) Anthropometric Methods
• Anthropometry is the measurement of body height, weight & proportions. It
is an essential component of clinical examination of infants, children &
pregnant women.
• These measurements are compared to the reference data (standards) of the
same age and sex group, in order to evaluate the nutritional status.
• Although they indicate the nutritional status in general , still they are not
used to identify specific nutritional deficiencies.
• They are used to evaluate both under & over nutrition .
• The measured values reflect the current nutritional status & don’t
differentiate between acute & chronic changes.

4. Other anthropometric Measurements
• Mid-arm circumference
• Skin fold thickness
• Head circumference
• Head/chest ratio
• Hip/waist ratio
Weight
The measurement of weight is most reliable criteria of assessment of health and
nutritional status of children. The weight can be recorded using a :
• Beam type weighing balance
• Electronic weighing scales for infants and children.
• Bathroom type of mechanical scale (very unreliable).
• Salter spring machine (in field conditions)

7. Length or Height/Stature Measurement Technique
Up to 2 years of age Recumbent Length is measured with the help of an Infantometer.
In older children Standing Height or Stature is recorded. It is
convenient to use an Inbuilt Stadiometer affixed on the wall which provides a direct
read out of height with an accuracy of +/- 0.1cm.

8. Technique of length measurement
• The infant is placed supine on the infantometer.
• Assistant or mother is asked to keep the vertex or
top of the head snugly touching the fixed vertically
plank.
• The leg are fully extended by pressing over the knee
and feet are kept vertical at 90 ⁰, the movable pedal
plank of infantometer is snuggly opposed against soles and length is
read from scale.

11. HEAD CIRCUMFERENCE
• Brain growth takes place 70% during fetal life, 15% during infancy and remaining 15% during pre-
school years.
• Head circumference are routinely recorded until 5 years of age.
• If scalp edema or cranial moulding is present , measurement of scalp edema may be inaccurate
until fourth or fifth day of life .
•The head circumference is measured by placing the tape over the occipital protuberance at the
back and just over the supraorbital ridge and the glabella in front.
Expected head circumference in children
 At birth 34 – 35 cm
 2 months 38 cm
 3 months 40 cm
 4 months 41 cm
 6 months 42 - 43 cm
 1 year 45 – 46 cm

12. Chest circumference
• It is usually measured at the level of nipples, preferably in mid
inspiration.
• In children
<= 5years - lying down position
>5 years - standing position
Relationship between head size with Chest Circumference:
• At birth: head circumference > chest circumference by upto 3 cms.
• At around 9 months to 1 year of age:
head circumference = chest circumference,
• But thereafter chest grows more rapidly compared to the brain.
In malnourished children, chest size may be significantly smaller than
head circumference because growth of brain is less affected by
undernutrition. Therefore there will be considerable delay before
chest circumference overtakes head circumference.

14. MID-UPPER ARM CIRCUMFERENCE
• During 1-5 Yrs of age it remains reasonably static between 15-17cms among healthy children .
• It is conventionally measured over the left upper arm , at a point marked midway between acromion
(shoulder) and olecranon (elbow) with arm bent at right angle.
• The child is asked to stand or sit with the arm hanging loose at the side.
• MUAC is measured with a fiber glass or steel tape.
• If it is less than 12.5 cm it is suggestive of severe malnutrition.
• If it is between 12.5 -13.5 cm it is indicative of moderate malnutrition.
Bangle test – quick assessment of arm circumference. A fiber glass ring of internal diameter of 4 cm is
slipped up the arm, if it passes above the elbow, it suggests that upper arm is less than 12.5 cm and child is
malnourished.
Shakir tape – is a fiber-glass tape with
 red – less than 12.5 cm
 yellow – 12.5- 13.5 cm
 green – greater than 13.5 cm
shading so that paramedical workers can assess nutritional status without having to remember the normal
limits of mid arm circumference.

17. II)Biochemical Methods
Laboratory tests based on blood and urine can be important indicators of nutritional status, but
they are influenced by non nutritional factors as well. Lab results can be altered by
medications, hydration status, and disease states or other metabolic processes, such as stress .
In preterm infants, some biochemical markers are useful in the assessment of nutritional status,
helping to detect nutritional deficiencies before the appearance of clinical signs.
I) PROTEIN STATUS- Blood Urea Nitrogen, Serum prealbumin and Retinol binding protein.
II) BONE STATUS- Serum calcium, phosphate and alkaline phosphate.
III) METABOLIC AND ELECTROLYTE STATUS- Acid base balance, glucose, electrolytes, calcium,
phosphorous, and magnesium.
IV) IRON STATUS- Serum ferritin.

18. III) Clinical methods
Clinical methods of assessing nutritional status involve checking signs of deficiency
at specific places on the body. Clinical signs of nutrient deficiency include:
Pallor (on the palm of the hand or the conjunctiva of the eye),
Bitot’s spots on the eyes,
Pitting oedema,
Severe visible wasting

19. Checking for bilateral pitting oedema in a child
In order to determine the presence of oedema, you should apply normal thumb
pressure on both feet for three seconds. If a shallow print persists on both feet, then
the child has nutritional oedema (pitting oedema). You must test for oedema with
finger pressure because you cannot tell by just looking.

20. Bitot’s Spots
These spots are a creamy colour and appear on the
white of the eye.
Visible severe wasting
In order to determine the presence of visible severe
wasting for children younger than six months, you
will need to ask the mother to remove all of the
child’s clothing so you can look at the arms, thighs
and buttocks for loss of muscle bulk. Sagging skin and
buttocks indicates visible severe wasting

21. Sign/symptom Nutritional abnormality
Pale: palms, conjunctiva, tongue
Gets tired easily; loss of appetite shortness of breath
Anaemia: may be due to the deficiency of iron, folic,
vitamin B12, acid, copper, protein or vitamin B6
Bitot’s spots (whitish patchy triangular lesions on the side
of the eye)
Vitamin A deficiency
Goitre (swelling on the front of the neck) Iodine deficiency disorder
Clinical signs and symptoms of nutritional problems

22. IV) Dietary methods
Dietary methods of assessment include looking at past or current intakes of
nutrients from food by individuals or a group to determine their nutritional
status.
Dietary assessments among infants and preschool children are complicated by the
facts that dietary habits change rapidly in infancy.
You can ask what the mother and the child have eaten over past 24 hours and
Use this data to calculate the dietary score.
The dietary assessment of an infant should include:
 Evaluation of breastfeeding frequency and duration
 Infant formula dilution and intake
 Appropriate amount and types of complementary foods
 Feeding skill development

23. Indirect Methods of Nutritional Assessment
The indirect methods use community health indices that reflect nutritional
influences These include three categories:
•Ecological variables including crop production
•Economic factors i.e. per capita income, population density & social habits
•Vital health statistics particularly infant & under 5 mortality & fertility indices

24. REFERENCES:
I) Nutrition Module: 5. Nutritional Assessment
https://www.open.edu/openlearncreate/mod/oucontent/view.php?
id=318&printable=1
II) https://www.encyclopedia.com/sports-and-everyday-life/food-
and-drink/food-and-cooking/nutritional-assessment
III) Dietary assessment methods for micronutrient intake in infants,
children and adolescents: a systematic review
https://www.cambridge.org/core/journals/british-journal-of-
nutrition/article/dietary-assessment-methods-for-micronutrient-
intake-in-infants-children-and-adolescents-a-systematic-
review/FDEE4D9AAA656EA9D47EF3F736A85BCF

25. PRESENTED BY
SOUNDARYA VIJAYAKUMAR
I MSC FSN