Tuesday, July 11, 2017

Diet Assessment in Pediatrics: History taking skill

As a part of history taking, Dietary assessment becomes an important part of pediatric history. As childhood is the age of rapid growth and development, any lag in diet and nutrition will manifest with long-term effects if not addressed in time.  One of the common nutritional manifestations is Stunting, which is very much a prevalent issue as per Nepal Demographic Health Survey Report.

Diet History or Assessment can be made is 4 ways:

The list of methods for dietary assessment:
1.       24 hours Dietary Recall
2.       Food Records
3.       Diet history
4.       Food frequency questionnaire


While making a diet assessment in different age group children:


Children < 2 years old

Ask about exclusive breastfeeding, Formula feeding.
 Complementary feeding- type, frequency, amount, preparation and brand.


For children > 2 years:

Quantity, type, and frequency. Feeding environment, habit and pattern.


In All children

Appetite, dietary restriction, food aversion and drug use like vitamins and minerals supplementation.



History must be taken from parents or care-giver or from patient if he/she is able to comprehend well.

24 Hours Recall Method:
Most commonly used method in bedside clinical teaching. Pre-illness recall of diets from morning breakfast to night dinner is made, along with amount of intake is listed. Common utensils are used to estimate the amount of intake.
Eg.  Katori – small – 75 ml, large- 150 ml, Tea glass- 200ml, plastic cup- 100ml, tea spoon- 5 ml, table spoon- 10 ml etc.
Caloric Value for corresponding foods are calculated.


  Usual Intake/Diet History
·         This method asks the patient to recall a typical daily intake pattern, including amount, frequencies and methods of preparation. This intake history should include all meals, beverages and snacks.
·         An excellent method to better understand a patient’s nutritional status is to use a usual intake and lifestyle recall. 


Food Frequency Questionnaire
·         This method makes use of a standardized written checklist where patients check off the particular foods or type of foods they consume. It is used to determine trends in patients’ consumption of certain foods. The checklist puts together foods with similar nutrient content, and frequencies are listed to identify daily, weekly, or monthly consumption.
·       

Dietary Food Log
·         This method asks the patient to record all food, beverage and snack consumption for a one- week period. Specific foods and quantities should be recorded. The data from the food log may later be entered into a computer program, which will analyze the nutrient components of the foods eaten according to specific name brands or food types. Patients are asked to enter data into the food log immediately after food is consumed so they do not forget.


·      Source: Various Academic Institute Websites