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Canete, Pamela Q.

Chapter 2
Review of Literature

Nutritional status affects every pediatric patient's response to illness. Good

nutrition is important for achieving normal growth and development.
Nutritional assessment therefore should be an integral part of the care for
every pediatric patient. Routine screening measures for abnormalities of
growth should be performed on all pediatric patients. Those patients with
chronic illness and those at risk for malnutrition should have detailed
nutritional assessments done. Components of a complete nutritional
assessment include a medical history, nutritional history including dietary
intake, physical examination, anthropometrics (weight, length or stature,
head circumference, midarm circumference, and triceps skinfold thickness),
pubertal staging, skeletal maturity staging, and biochemical tests of
nutritional status. Alternative measures for linear growth assessment (e.g.,
lower leg and upper arm measures) can be performed on patients unable to
stand or who have musculoskeletal deformities. Bone densitometry can be
used to assess bone mineralization and the risk of fracture. Nutritionally at
risk patients may benefit from determination of resting energy expenditure
by indirect calorimetry. The use of age, gender, and disease-specific growth
charts is essential in assessing nutritional status and monitoring nutrition
interventions. The importance of accurate measurements using trained
personnel and appropriate equipment cannot be overemphasized
(Mascarenhas, Zemel & Stallings, 1998).
Because of the importance of adequate nutrition for children, researchers are
beginning to
assess nutritional offerings for children in various settings. Structured
childcare settings are
examples of such settings. In order to determine whether children who
participate in a structured childcare setting are receiving proper nutrition for
adequate nutritional status, researchers must use nutritional assessments
reviewing anthropometric measurements, nutrient blood levels, blood
pressure, and dietary intakes.
A careful search of the current literature on the nutritional status of children
identified a minimal number of studies conducted on the nutritional status of
groups of children using a full nutritional assessment. Although these were

studies on nutrient intake in children, these studies usually focused on the

dietary component rather than
associating other components of a nutrition assessment. This review of the
literature describes the research studies done on the dietary component of
nutritional assessment.
Skinner et al. (1999) used a longitudinal design for a study on the nutrient
and food
intakes of 72 Caucasian preschool children primarily from families of middle
and upper
socioeconomic status and to compare children's nutrient intakes with the
current recommendations. Skinner et al. determined that preschool children
aged 24 to 60 months
consistently consumed less than the RDA/AI for energy, zinc, folate, and
vitamin D and E. Therefore, a greater proportion of nutritious foods need to
be emphasized with
preschool-aged children.

Current Nutritional Problems among Children

Weight Status
A large number of research studies have indicated that childhood overweight
noticeably in the last years and the problem continues to increase. Being
overweight as a child
can increase the child's risk of being overweight as an adult. This may
develop into long-term
health conditions, lower quality of life, increased medical costs, and higher
morbidity and
mortality rates (Christoffel & Ariza, 1998). The major causes for children
being overweight in
the United States are excess energy intake, low energy expenditure, or both
(Ogden et al., 1997).According to the National Health and Nutrition
Examination Survey (NHANES), the mean
energy and fat intakes among preschoolers has not increased during the last
20 years (Ogden et
al., 1997).
There is much less research on the issue of childhood underweight in the U.S.
than research on overweight children. Research on underweight in the U.S. is

necessary as a result of the decrease in the prevalence rates of underweight

in the U.S
over the last 30 years (Onis, Blossner, Borghi, Frongillo, & Morris, 2004). Onis
colleagues have estimated that around 3.1% of children in the U.S. suffer
from 12
underweight. However, underweight has a much greater prevalence
worldwide than in
the U.S. (Chang, Walker, Grantham-McGregor, & Powell, 2002). Chang and
estimate anywhere from 17% to 25% children worldwide are identified as
Although few research studies have been conducted on nutritional
assessment in the
pediatric population, the studies that have been completed indicate that
there is a need for more research in this area. Additional research studies are
needed to identify children's nutritional status for proper detection of any
early disease development. Early detection can lead to the awareness of
some nutritional conditions that could affect the child's health.