II. Health Supervision

Screening Services and Assessments: Nutritional Assessment and Screening

The nutritional status of infants, children, and adolescents affects their growth and development as well as their ability to resist disease. Optimal nutrition can prevent health problems such as iron-deficiency anemia, undernutrition, obesity, heart disease, Type II diabetes, and high blood pressure. Nutrition screening helps to identify nutritional risk factors and provides opportunities for the promotion of healthy eating behaviors.

Periodicity and Guidelines for Nutrition Screening

HealthCheck requires a nutrition screening and assessment at each preventive health visit from birth to 21 years.

Screen according to the following protocol:

• Perform a complete physical examination, including body measurements.
• Record accurate measurements of the child's height and weight—these are among the most important indices of nutritional status.
• Ask the family about dietary practices to identify unusual eating habits or diets that are deficient in nutrients and calories, or excessive in cholesterol and fat.
• Screen children and teens at high risk for iron-deficiency anemia with a blood test (hematocrit or hemoglobin).
• Check serum cholesterol or lipoprotein levels of children and teens at high risk for elevated cholesterol levels.

If dietary inadequacy, obesity, or other nutrition problems are present: Investigate family, socioeconomic, or any other community factors. Determine the quality and quantity of the child’s diet (dietary intake, food acceptance, meal patterns, methods of preparing and storing food, and use of food assistance programs). Perform further physical and laboratory examinations. Perform preventive, treatment, and follow-up services, including dietary counseling and nutrition education. Refer the family to WIC Program when appropriate.

Early Identification and Prompt Referral

Referral should be considered for the following:

• Children who have continued or excessive weight loss or no weight gain over a period of time
• Children who are considerably overweight in proportion to their height or are above the 90th percentile in weight-for-height
• Children with other variations from expected growth parameters (such as weight-for-age and height-for-age) below the 5th percentile. Adjustment for prematurity in infancy and parent-specific adjustment for height may be considered.
• Children with congenital conditions or chronic illness affecting ability to meet nutrient need (e.g., cleft palate, congenital heart defects, cystic fibrosis, inborn errors of metabolism, physical or mental disabilities that affect feeding)
• Children with elevated blood lead levels, iron deficiency anemia, food allergies, or evidence of drug/nutrient interaction.

Story M, Holt K, Sofka D, eds. 2002. Bright Futures in Practice: Nutrition (2nd ed.). Arlington, VA: National Center for Education in Maternal and Child Health.

Story M, Holt K, Sofka D, Clark EM, eds. 2002. Bright Futures in Practice: Nutrition—Pocket Guide. Arlington, VA: National Center for Education in Maternal and Child Health.