Nutrition assessment and eating
disorders in Children
Prepared by
Raveen Isamel Abdullah
B.CS.in Nursing
Hawler Medical University
College of nursing
2016-2017

OUTLINES
• Nutritional assessment
• Methods of assessment
• Eating disorders
• Bulimia
• Anorexia

Objectives
• By end of seminar audience will be able to
assess level of nutrition in children
• They will be able to diagnose child with eating
disorder

Nutritional assessment
• is the interpretation of anthropometric,
biochemical (laboratory), clinical and dietary
data to determine whether a person or groups
of people are well nourished or malnourished
(over-nourished or under-nourished).

Nutritional assessment (ABCD (methods
• A. Anthropometry(human measurements )
• B. Biochemical/biophysical methods
• C. Clinical methods
• D. Dietary methods

Anthropometric measurements used
to assess growth
• Length: To measure the length of a child
under two years

Anthropometric measurements used
to assess growth
• Height: children who are two years old or more

Anthropometric measurements used
to assess growth
Weight:
• Salter Scale (spring balance ) is used for
measuring the weight of children under two
years old, to the nearest 0.1 kg.
• Beam balance /Electronic balance for children
above 2 years .

Spring balance

Beam Balance

Head circumference:
• is the measurement of the head along the supra
orbital ridge (forehead) anteriorly and occipital
prominence (the prominent area on the back part of
the head) posteriorly.
• is useful in assessing chronic nutritional problems in
children under two years old as the brain grows faster
during the first two years of life.
• But after two years the growth of the brain is more
sluggish and HC is not useful.
Anthropometric measurements used
to assess growth

Head circumference

Converting measurements to indices
• An index is a combination of two measurements
or one measurement plus the person’s age.
 Weight-for-age is an index used in growth
monitoring for assessing children who may be
underweight
 Height-for age is an index used for assessing
stunting (chronic malnutrition in children).
 Weight-for-height is an index used for assessing
wasting (acute malnutrition).

• Stunting is defined as a low height for age of the
child compared to the standard child of the same
age. Stunted children have decreased mental and
physical productivity capacity
• Wasting is defined as a low weight for the height
of the child compared to the standard child of the
same height. Wasted children are vulnerable to
infection and stand a greater chance of dying.
Converting measurements to indices

Body mass index: is the weight of a child or
adult in kg divided by their height in meters
squared: Weight (kg)/(Height in meters)2
• more than 2500 grams =normal birth weight
• 1500–2499 grams=low birth weight
• less than 1500 grams=very low birth weight
Converting measurements to indices

Example of BMI

Converting measurements to indices

Converting measurements to indices

Anthropometric measurements used
to assess body composition
• In assessing body composition (fat content)
the body is considered to be made up of two
compartments: the fat mass and the fat free
mass.

• Measurements of fat-mass (fatness) BMI
• Measuring fat-free mass (muscle mass)
Anthropometric measurements used
to assess body composition

Mid Upper Arm Circumference
(MUAC)
is the circumference of the upper arm at the
midway between the shoulder tip and the
elbow tip on the left arm. The mid-arm point
is determined by measuring the distance from
the shoulder tip to the elbow and dividing it
by two.

• MUAC is a good screening tool in determining
the risk of mortality among children, and
people living with HIV/AIDS
• A low reading indicates a loss of muscle mass.
Mid Upper Arm Circumference
(MUAC)

MUAC Procedure
• A special tape is used for measuring the MUAC
of a child.
• The tape has three colors, with the red
indicating severe acute malnutrition, the
yellow indicating moderate acute malnutrition
and the green indicating normal nutritional
status.

MUAC Procedure

MUAC Procedure

Clinical methods of assessing
nutritional status
• Clinical methods of assessing nutritional status
involve checking signs of deficiency at specific
places on the body or asking the patient
whether they have any symptoms that might
suggest nutrient deficiency from the patient.

Clinical signs of nutrient deficiency
• Pallor (on the palm of the hand or the conjunctiva
of the eye).
• Bitot’s spots on the eyes.
• Pitting oedema.
• Goitre .
• Severe visible wasting.

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).
• Test for oedema with finger pressure because
you cannot tell by just looking.

Grades of oedema
• Depending on the presence of oedema on the
different levels of the body it is graded as
follows. An increase in grades indicates an
increase in the severity of oedema.
• 0 = no oedema
• + = Below the ankle (pitting pedal oedema)
• ++ = Pitting oedema below the knee
• +++ = Generalised oedema.

Checking for bilateral pitting oedema
in a child

Bitot’s spots
• These are a sign of vitamin A deficiency these
spots are a creamy colour and appear on the
white of the eye.

Goitre
• Goitre is a swelling on the neck and is the only
visible sign of iodine deficiency

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

Visible severe wasting

Dietary methods of assessing
nutritional status
• 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.
• Ask what the family or the mother and the
child have eaten over the past 24 hours and
use this data to calculate the dietary diversity
score.

Dietary diversity
• is a measure of the number of food groups
consumed over a reference period, usually 24
hours. Generally, there are six food groups that
our body needs to have everyday.
• Dietary diversity score is an indicator of both the
balance of nutrient consumption and the level of
food security (or insecurity) in the household.
The higher the dietary diversity score in a family,
the more diversified and balanced the diet is and
the more food-secure the household.

• As part of the dietary assessment you should
also check the salt iodine level of households
using the single solution kit (SSK).
• This enables you to determine whether the
salt iodine level is 0, more than 15 parts per
million (PPM) or less than 15 PPM
Single Solution kit (SSK)

Single Solution kit (SSK)

Eating Disorder
• Eating Disorders describe illnesses that are
characterized by irregular eating habits and
severe distress or concern about body weight
or shape.

• Anorexia Nervosa and Compulsive Eating are
the most common among young children.
Eating Disorder

A number of factors combine to trigger eating
disorders:
• Biology and genetics
• Cultural pressures, including the media
• Peer pressure to be abnormally thin or
muscular
Eating Disorder

The Origins of Eating Disorders in
Children
• history of early feeding problems, such as “fussy or
picky” eating though this has not been identified as a
direct cause of an Eating Disorder.
• Almost half of those diagnosed with disorders by the
age of 12 had a close family member with a mental
health problem such as anxiety or a mood disorder.
• Eating disorders in children can be developed because
of low self-esteem, and their focus on weight can be an
attempt to gain a sense of control at a time when
their lives feel increasingly out of control.

The Serious Consequences of Eating
Disorders in Children
A child who suffers from anorexia nervosa, bulimia, or
any other eating disorder could suffer from:
• Malnutrition
• Injuries to the internal organs
• Other medical complications such as:
– Heart problems
– Kidney failure
– Stagnation in the physical development
• In extreme cases, eating disorders can lead to death.
Studies have shown a range of mortality rates from 5 to
18 percent.

Treatments Available for Eating
Disorders in Children
• Biologically, while some children do not need
psychotropic medications, the majority of children
that meet criteria for an anxiety or a mood disorder
will benefit from initiation of a psychotropic
medication as treatment of these disorders help
facilitate the treatment of the eating disorders.
• Children that do not have comorbid mood or anxiety
disorder may also benefit from as-needed anti-anxiety
medication at the initial stage of the re-feeding
process, as this decreases anxiety during meal times
and allows the child to overcome the fear of eating.

Anorexia
• Teen with anorexia view themselves as heavy,
even when they are dangerously skinny. They
are obsessed with being thin and refuse to
maintain even a minimally normal weight.

Anorexia complications
• Damage to major organs, especially the brain,
heart and kidneys
• Irregular heartbeat
• lowered blood pressure, pulse, body
temperature, and breathing rates
• Sensitivity to cold
• Thinning of bones

Symptoms of anorexia
• anxiety, depression, perfectionism, or being highly self-critical
• Dieting even when one is thin or emaciated
• excessive or compulsive exercising
• intense fear of becoming fat, even though one is underweight
• menstruation that becomes infrequent or stops
• rapid weight loss, which the person may try to conceal with loose
clothing
• strange eating habits, such as avoiding meals, eating in secret,
monitoring every bite of food, or eating only certain foods in small
amounts
• unusual interest in food

Treating anorexia
• The first aim of treatment is to bring the young person back
to normal weight and eating habits. Hospitalization,
sometimes for weeks, may be necessary.
• In cases of extreme or life-threatening malnutrition, tube or
intravenous feeding may be required.
Long-term treatment addresses psychological issues.
Treatments include:
• Antidepressant medication
• behavioral therapy
• psychotherapy
• support groups

Bulimia
• A condition in which a child grossly overeats
(binging) and then purges the food by
vomiting or using laxatives to prevent weight
gain
• Binge eating, a condition in which a child may
gorge rapidly on food, but without purging

Symptoms of bulimia
• abusing drugs and alcohol
• abusing laxatives and other treatments to prevent weight gain
• anxiety
• bingeing on large amounts of food
• eating in secret or having unusual eating habits
• excessive exercise
• mood swings
• overemphasis on physical appearance
• regularly spending time in the bathroom after eating
• sadness
• scarring on knuckles from using fingers to induce vomiting
• unusual interest in food
• vomiting after eating

Complications of Bulimia
Stomach acids from chronic vomiting can cause:
• damage to tooth enamel
• inflammation of the esophagus
• swelling of the salivary glands in the cheeks

Treatment of Bulimia
• Antidepressants medication
• behavior modification
• individual, family, or group therapy
• nutritional counseling

Thanks