Monday, February 20, 2012

Comparing Adult with Pediatric Nutritional Assessment

By Joyce L. Hornick

In the fall, I worked at a community hospital as a clinical dietitian helping adult patients. In January, I got the opportunity to work as a clinical dietitian at a children’s hospital helping pediatric patients. Even though we’re all humans, the nutritional care of these two populations is completely different.

Estimating energy and protein needs of an adult follows systematic scientific equations. The energy and protein needs of most adults do not vary widely, from person to person or from day to day. The primary goal of calculating energy needs is typically to maintain current nutritional status if well-nourished, and to prevent loss of lean body mass. Even with chronic illness, needs estimation is relatively easy to achieve. Specific dietary and food recommendations are made depending on the diseases a patient may have and how they can use food to help improve their condition or prevent further progression of the illness.

In infants, the estimation process is much more complex, especially if the infant has a chronic illness or was born with a congenital or genetic defect. In older children and adolescents, the estimation process is still complex, though the rate of growth is typically at a slower pace. The primary goal of energy and protein estimation is to continue with a consistent upward growth pattern. It is very important to prevent trends toward a negative growth curve which could lead to Failure to Thrive. Depending on the type of illness a child has, their energy needs could be double what a healthy infant needs.

The energy needs of pediatric patients are based on their physical body weight. For a newborn, whose weight should be increasing typically by 25-30 grams per day, their energy needs will need to be evaluated every month to month and a half. If the chronic condition they have increases their metabolism, they may need twice as many calories to have optimal weight gains and their energy needs may need to be evaluated more often. Specific dietary and food recommendations are made much the same way they are made with adults. Though, since children tend to be pickier eaters than adults, there is a higher risk of malnutrition.

I was quite naïve upon starting my clinical pediatric rotation. I thought to myself, how hard could it be? Children are smaller than adults, but how much different can their nutritional needs be? In reality, their needs are much different than an adult. It was eye opening to see how detailed some pediatric patients needed their nutritional needs planned out. Children with special dietary needs due to illnesses need individualized care plans, just like adults, but the risk of malnutrition is much greater, making the care plan that much more important and even more detailed.

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