Assessment of

Malnutrition and Anemia

Dr. Karwan Hawez
Family Medicine Specialist
College of Medicine
 Outline of The Lecture

• Objectives.

• Introduction.

• Clinical Case.

• Assessment of nutritional status

• Tables.

• Solution to the clinical case.

• Conclusion.
 Objectives
1. To learn how to assess a child for his/her
nutritional status and anemia.
2. To understand what are the indicators for
this assessment.
3. To know the requirements for this
assessment.
4. To learn also how to classify each child’s
nutritional status according to your
assessment and how to manage him/her.
 Introduction
• Check all children for signs of MN in the
routine visit and according to the need.

• A sick child can be malnourished, but the

health worker or the child’s family may not
notice the problem.
 Introduction (cont.)
• Even the child with mild and moderate
MN have an increased risk of disease and
death.
• Some MN can be treated at home.
• Sever cases need referral to hospital
(NRC), blood transfusion, or specific Rx of
a disease contributing to MN (such as
TB).
Kwashiorkor
Marasmus
 Clinical Case

Ahmed is an 18 months (i.e. 1.6 years) old and

weighs 7kg. His length is 73 CM. Interpret his

nutritional status according to IMCI growth

charts.
 Assessment of Nutritional Status

The assessment is by these indicators:

1. Height or length for age.

2. Weight for age.

3. Weight for height.

4. BMI for age.

Height and Length measurement
 Assessment of Nutritional Status
Steps for assessment of Nutritional Status:
1. Gender identification.
2. Age calculation.

Notes:
1. If the age is <3 months, record by complete weeks.
2. If the age is between 3 months to <1 year, record by
complete months.
3. If age ≥ 1 year, record by years and complete months.
 Assessment of Nutritional Status
Length/Height for Age Charts:
Assessment Classification Treatment
Length or height for age > +3 Very tall → Check the mother and father
Z-score height
→ Refer to hospital.

Length or height for age < -3 Sever stunting → Refer to hospital

Z-score

Length or height for age < -2 Stunting → Monitor the growth trend.
Z-score → Advice and counsel the mother
on feeding.

Normal range No stunting → Assess the feeding for the child.

→ Advice and counsel the mother
on feeding.
 Assessment of Nutritional Status (cont.)
Weight for Age Charts:
Assessment Classification Treatment

Weight for age < -3 Z-score Sever underweight → Prevent low blood sugar
→ Prevent hypothermia.
→ Urgent refer to hospital.
Weight for age < -2 Z- Underweight → Assess the feeding for the child.
score → Advice and counsel the mother
on feeding.
→ F/Up in 5 days if feeding problem
persist.
→ Advice the mother when to
return immediately.
→ F/Up after 30 days
Normal range No underweight → Assess the feeding for the child.
→ Advice and counsel the mother
on feeding.
Assessment of Nutritional Status (cont.)
Weight for Length/Height Charts:
Assessment
Weight for Length or height > +3 Z-score
Weight for Length or height > +2 Z-score
Weight for Length or height > +1 Z-score
Weight for Length or height < -3 Z-score
Weight for Length or height < -2 Z-score
Normal range
Classification Treatment
Obesity → Advice and counsel the mother
→ F/Up after 30 days
→ Do not try to reduce body wt, try to keep the wt
with increase in length and age until reach normal
wt.
→ Refer to hospital.
Overweight → Assess the feeding for the child.
→ Advice and counsel the mother on feeding
according to the mother card.
→ Do not try to reduce body weight, try to keep
the wt with increase in length and age until reach
normal wt.
→ F/UP after 30 days
Possible risk of overweight → Assess the feeding for the child.
→ Advice and counsel the mother on feeding.
→ F/UP after 30 days
Sever wasting → Give vitamin A.
→ Prevent low blood sugar.
→ Prevent hypothermia.
→Urgent referral to hospital
Wasting → Advice and counsel the mother on feeding.
→ F/UP in 5 days if feeding problem present.
→ Advice the mother when to return immediately.
→ F/UP after 30 days.
No overweight, no wasting → Advice and counsel the mother on feeding
Assessment of Nutritional Status (cont.)
BMI for Age Charts:

Assessment Classification Treatment

BMI for age > +3 z-score
BMI for age > +2 z-score
BMI for age > +1 z-score Possible risk of overweight
BMI for age <-3 z-score
BMI for age < -2 z-score
Obesity → Advice and counsel the mother
→ F/Up after 30 days
→ Do not try to reduce body wt, try to keep the wt
with increase in length and age until reach normal
wt.
→ Refer to hospital.
Overweight → Assess the feeding for the child.
→ Advice and counsel the mother on feeding
according to mother card.
→ Do not try to reduce body weight, try to keep
the wt with increase in length and age until reach
normal wt.
→ F/UP after 30 days
→ Assess the feeding for the child.
→ Advice and counsel the mother on feeding.
→ F/UP after 30 days
Sever wasting → Give vitamin A.
→ Prevent low blood sugar.
→ Prevent hypothermia.
→Urgent referral to hospital
Wasting → Advice and counsel the mother on feeding.
→ F/UP in 5 days if feeding problem present.
→ Advice the mother when to return immediately.
→ F/UP after 30 days.
 Clinical Case Management
Steps for assessment and classification of
nutritional status of Ahmed:
1. Ahmed is a male gender.
2. He is 1 year and 6 months (1.6 year).
The assessment is by these indicators:
1. Height or length for age.
2. Weight for age.
3. Weight for height.
4. BMI for age.
 Clinical Case Management (cont.)

The 1st indicator for assessment and

classification of the Nutritional Status of
Ahmed:
1. Height or length for age.
1.6 year and 73.7cm = below -3 Z-score =
Sever stunting.
 Clinical Case Management (cont.)
The 2nd indicator for assessment and
classification of the Nutritional Status of
Ahmed:
1. Weight for age.
1.6 year and 7Kg = below -3 Z-score = Sever
underweight.
 Clinical Case Management (cont.)
The 3rd indicator for assessment and
classification of the Nutritional Status of
Ahmed:
1. Weight for length.
7Kg and 73.7cm = below -3 Z-score = Sever
wasting.
 Clinical Case Management (cont.)
The 4th indicator for assessment and
classification of the Nutritional Status of
Ahmed:
1. BMI for age.
7Kg and 73.7cm = below -3 Z-score = Wasting.
 Clinical Case Management (cont.)
The Rx for Ahmed:
• Give vitamin A.
• Prevent low blood sugar.
• Prevent hypothermia.
• Urgent referral to the hospital.
 Conclusion
1. You should assess the nutritional status of
any child less than 2 years of age.
2. Assessment of a child ≥2 years is indicated
if you suspect MN.
3. The first step in the assessment is to
determine the age and sex of the child.
4. Indicators for assessment are wt for age, ht
for age, wt for ht, and BMI for age.
Thank You