Assessment

Instructions for Assessment

Assessment for nutritional disorders follows three essential steps:

  1. Initial Screening: The initial screener is used to determine if the caregiver perceives their child to have a problem with nutrition and do the anthropometrics suggest that this child is over/under -nourished.
    • This step also includes plotting the child's height and weight on a growth chart to determine if their height/weight ratio (BMI) is within a healthy range.
  2. Secondary Screening: This assessment is used to examine the etiology of the nutritional disorder and the areas of concern in order to determine what interventions may be necessary.
  3. Treatment Planning: By using the Treatment Planning/Etiology Guide, interventions can be used to tailor treatment to the specific needs of the child and the family.
 Screening Tools

Instructions for Screening and Scoring

Initial Screening

The initial screener is used to assess, 1) if the caregiver perceives the child to have an issue with their weight and nutrition, and 2) is the child at risk for a nutritional disorder based on their height and weight measurements.

Caregivers will be asked to complete the initial screener and return it to the provider upon completion. The provider will then take accurate height and weight measurements, and plot those measurements on the appropriate growth chart. If the child is below the 5th percentile or above the 85th percentile, the Undernutrition Secondary Screener and the Overnutrition Secondary Screener should be distributed to the caregivers to complete.

If the caregiver endorses that they believe their child has an issue with their weight but falls into a healthy range, the provider may consider having a discussion with the caregiver about developmentally healthy weights.

Secondary Screening

The secondary screeners are used to assess the etiology of the nutritional disorder and determine areas of concern in order to determine what interventions may be necessary. Each question on the screener was designed to identify the different etiological constructs that may be contributing to the nutritional disorder.

Caregivers are asked to complete the front-page of the secondary screener and return it to the provider for scoring.

On the scoring chart for the secondary screener, each column corresponds to an etiological construct and each question on the screener corresponds to a row on the scoring chart. Within each row, the different etiological constructs pertaining to that question are identified. If a caregiver responds to the question in such a way that is not accordance with appropriate nutritional or behavioral practices (i.e. child does not eat vegetables, meals are eaten in front of the television), each box within that row receives a tally. Once all the questions have been scored, the tallies in each column are added up and total scores are recorded in the appropriate box. Clinical cut-offs have been provided, and if the total score of that column exceeds the clinical cut-off, this etiological construct should be identified as an area for intervention.

Screening Tools

Initial Screener (PDF)
Initial Screener - Spanish (PDF)

Undernutrition Secondary Screener (PDF)
Undernutrition Secondary Screener - Spanish (PDF)

Overnutrition Secondary Screener (PDF)
Overnutrition Secondary Screener - Spanish (PDF)

Screening Reports

Overnutrition Screening Report (PDF)
Undernutrition Screening Report (PDF)

 Growth Charts

Growth charts are an important tool for determining whether a child is at risk for nutritional problems. Growth charts are used to plot a child's height-to-weight ratio and/or body mass index (BMI) for their age to determine if they are within a healthy developmental range. A child's growth can be significantly increased or decreased based on the child's nutritional intake, and children whose BMIs fall within the lowest and highest percentiles for their age are considered most at risk for nutritional disorders.

Instructions for Using Growth Charts

  1. Obtain accurate measurements for both the child's height and weight.
  2. Calculate the child's BMI. CDC BMI Calculator
  3. Select the most appropriate growth chart for the child's age.
  4. Plot the child's measurements.
    • Age is plotted along the horizontal axis - use a straight-edge to draw a vertical line up through that point.
    • Weight and BMI are plotted along the vertical axis - use a straight-edge to draw a horizontal line across through that point.
    • Make a dot where the two lines intersect.
  5. Interpret the measurements.
    • If a child is below the 5th percentile, they may be at risk for undernutrition.
    • If a child is above the 85th percentile, they may be at risk for overnutrition.
    • When a child falls into an at-risk category for a nutritional disorder, further assessment is recommended. The Secondary Screener should be used as a follow-up assessment for nutritional risk.

CDC Growth Charts

Female
0-36 Months: Head-Circumference-for-Age and Weight-for-Length Percentiles (PDF)
0-36 Months: Length-for-Age and Weight-for-Age Percentiles (PDF)

2-20 Years: Body Mass Index-for-Age Percentiles (PDF)
2-20 Years: Stature-for-Age and Weight-for-Age Percentiles (PDF)

Male
0-36 Months: Head-Circumference-for-Age and Weight-for-Length Percentiles (PDF)
0-36 Months: Length-for-Age and Weight-for-Age Percentiles (PDF)

2-20 Years: Body Mass Index-for-Age Percentiles (PDF)
2-20 Years: Stature-for-Age and Weight-for-Age Percentiles (PDF)

 Etiology/Treatment Planning

 

  Eats Too Little
Food selectivity; Undernutrition/Failure to Thrive
Eats Too Much
Overnutrition; Hyperphagia
Etiological Constructs Diet
Enough to eat: Calories Balanced diet: Variety Developmentally appropriate diet; Adequate fluid; Supplement(s)
A. Increase calories (foods and fluids)
B. Correct nutrient imbalances and/or deficiencies
C. Increase food variety
D. Provide nutrition education on typical feeding patterns
E. Nutrition tracking/diet record
F. Behavior management
A. Decrease calories (foods and fluids)
B. Correct nutrient imbalances and/or deficiencies
C. Behavioral methods for increasing food variety
D. Provide nutrition education on typical feeding patterns
E. Elimination of juice/empty calories
F. Nutrition tracking/diet record
G. Stimulus control
Physical Competence
Oral-motor; Neuromotor; Physical Defect; Hyper/hypotonia
A. Developmentally appropriate diet modifications
B. Referral worksheet
A. Referral worksheet
Appetite
Supplemental feeding-Tube Feeding, Oral supplement
A. Mealtime structure/schedule
B. Elimination of juice/empty calories
C. Constipation alleviation through fluids/fiber/meds
D. Appetite stimulant
E. Medical Evaluation
A. Stimulus control
B. Behavioral methods for increasing food variety
C. Constipation alleviation through fluids/fiber/meds
D. Medical Evaluation
Illness/Medical
Illness onset-Chronic, Acute; Treatment problems
A. Medical Evaluation
B. Referral worksheet
A. Medical Evaluation
B. Referral worksheet
Interaction/Management
Grazing; Setting; Structure; Social contingencies; Cue insensitivity; Distracting/unsupportive environment; Aversive conditioning; Division of responsibility
A. Positive Reinforcement
B. Extinction
C. Mealtime structure/schedule
D. Behavioral Contracting
E. Stimulus Control Strategies
A. Positive Reinforcement
B. Extinction
C. Mealtime structure/schedule
D. Elimination of juice/empty calories
E. Behavioral Contracting
F. Stimulus Control
G.
Education on Physical Activity
Child Constitution
Child Mood; Difficult Temperament; ADHD; Sensory Deficit; Choking phobia
A. Referral worksheet to address behavioral/psychiatric issues
B. Behavioral management
C. Behavioral contracting/goal setting
A. Referral worksheet to address behavioral/psychiatric issues
B. Behavioral management
C. Behavioral contracting/goal setting
Caregiver Competence
Parent mental illness; Malnutrition beliefs; Non-nurturant parenting
A. Nutrition education on typical feeding patterns
B. Referral worksheet to address parent mental illness
C. Referral worksheet for parent training
A. Nutrition education on typical feeding patterns
B. Education on developmentally appropriate expectations
C. Referral worksheet to address parent mental illness
D. Referral worksheet for parent training
Systemic
Poverty; Family stressor; Multiple Feeders; Lack of resources
A. WIC referral
B. Food bank/local resources
C. Nutrition education for limited budgets
A. WIC referral
B. Food bank/local resources
C. Nutrition education for limited budgets

 

Contact Us

E-mail the Nutritional Disorders Telehealth Network Project Team

Please contact us if you are interested in using any of the project materials or if you would like more information regarding the project.

Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
Directions & Maps
© 2015

Page Updated 03/11/2015
Top