ALL INDIA INSTITUTE OF MEDICAL SCIENCES , JODHPUR

COLLEGE OF NURSING

Seminar Presentation on:

History taking, nutritional assessment, family assessment

Subject- Pediatric Nursing

Submitted to Submitted by

Mrs. Sanjeeta Dara Namrata Ratnu

Assistant Professor M.Sc Nursing 1st year
College of Nursing College of Nursing
AIIMS, Jodhpur AIIMS, Jodhpur

Date of submission :- 5-SEPT-2023

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S.no. Topic Pg. No.

1. History taking 3

2. Nutritional assessment 9

3. Family assessment 24

4. Role of nurse in family 27

assessment

5. Research articles 28-30

6. Summary 31

7. Conclusion 31

8. Bibliography 31

Table of contents

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 HISTORY TAKING
Introduction-
In this seminar we will review the components of a complete pediatric history. It is
the art that requires the clinician to listen effectively to the complaint of patients.
When treating the patient information gathered by any means can crucially guide
and direct the care.

Performing the health history-

The format used for history taking can be:
1. Direct-The nurse ask the informant for information by direct interview .
2. Indirect-the nurse ask informant to fill some type of questionnaire.

Direct method is superior but time consuming then the indirect method

Outline of pediatric health history :

I. General information-
 Name
 Age
 gender
 Address
 Informant
 Education
 Provisional diagnosis
 Classification of age
 Ward/ bed no
 Date of admission
 Date of surgery (in any)

II. Chief complaint- major specific reason for the child’s and parents seeking of
health care.
III. History of illness-
 History of Present illness-to obtain all the details related to chief complaint.
 History of past illness-
i. Natal history- antenatal ,intranatal, postnatal
ii. Previous illness,injuries,or surgeries
iii. Allergies
iv. Immunizations
v. Current medication

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vi. Growth and development
Vii. Habits

IV. Review of system ( physical examination)- head to toes

V. Family medical history and family history-to identify the genetic conditions
that have family tendencies,exposure to communicable disease,family habits
that effects child health. Egs. Smoking alcohol.
Family composition , home and community environment, occupation and
education level of family members , culture and religious traditional, family
function and relationship.
VI. Psycho-social History-Information about the child self concept.
VII. Sexual history-information concerning sexual concern.
VIII. Nutrional assessment - information on adequacy of child’s nutritional intake
and needs.
a. Dietary intake
b. Clinical examination

GENERAL INFORMATION:
Much of the identifying information may already be available from other recorded
sources. However, if the parent and child seem anxious. use this opportunity to ask
about such information to help them feel more comfortable.

Informant - Informant is the person(s) who furnishes the information.

(1) He can be child, parent, or other
(2) should be reliable and willingness to communicate, and
(3) any special circumstances, such as the use of an interpreter or conflicting
answers by more than one person

Chief Complaint:
The chief complaint is the specific reason for the child's visit to the hospital. It may
be the theme, with the present illness viewed as the description of the problem. Elicit
the chief complaint by asking open- ended, neutral questions (such as "What seems
to be the matter?" "How may I help you?" or "Why did you come here today?").
Avoid labeling. type questions (such as "How are you sick?" or "What is the
problem?"). It is possible that the reason for the visit is not an illness or problem.

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Occasionally, it is difficult to isolate one symptom or problem as the chief complaint
because the parent may identify many. In this situation, be as specific as possible
when asking questions: For example, asking informants to state which one problem
or symptom prompted them to seek help now may help them focus on the most
immediate concern.

PRESENT ILLNESS:

The history of the present illness is a narrative of the chief complaint from its earliest
onset through its progression to the present. Its four major components are the
details of onset, a complete interval history, the present status, and the reason for
seeking help now. The focus of the present illness is on all factors relevant to the
main problem even if they have disappeared or changed during the onset, interval,
and present.

EGS:

If pain is a presenting complaint the SOCRATES acronym can be used to explore it further.

Site - Ask about the location of the pain:

“Where is the pain?”

Onset - Clarify how and when the pain developed:

“Did the pain come on suddenly or gradually?”

“When did the pain first start?”

“How long have you been experiencing the pain?”

Character - Ask about the specific characteristics of the pain:

 “How would you describe the pain?” (e.g. dull ache, throbbing, sharp)
 “Is the pain constant or does it come and go?”

Radiation - Ask if the pain moves anywhere else:

 “Does the pain spread elsewhere?”

Associations - Ask if there are other symptoms which are associated with the pain:

 “Are there any other symptoms that seem associated with the pain?”

Time course - Clarify how the pain has changed over time:

 “How has the pain changed over time?”

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Exacerbating or relieving factors - Ask if anything makes the pain worse or better:

 “Does anything make the pain worse?”

 “Does anything make the pain better?”

Severity - Assess the severity of the pain by asking the patient to grade it on a scale of 0-10:

 “On a scale of 0-10, how severe is the pain, if 0 is no pain and 10 is the worst pain you’ve
ever experienced?

PAST ILLNESS:The history contains information relating to all previous aspects

of the child's health status and concentrates on several areas that are ordinarily
passed over in the history of an adult, such as birth history, detailed feeding history,
immunizations, and growth and development. Use a combination of open-ended and
fact-finding questions.

For example - "Tell me about your child's birth" - to provide the informants the
opportunity to relate what they think is most important. Ask fact-finding questions
related to specific details whenever necessary to focus the interview on certain
topics.

Birth history- The birth history includes all data concerning

1. the mother's health during pregnancy,

2. the labor and delivery, and
3. the infant's condition immediately after birth. Because prenatal influences have
significant effects on a child's physical and emotional development, a thorough
investigation of the birth history is essential.

It is best to approach the topic of parental acceptance of pregnancy through indirect

questioning. Asking the parents if the pregnancy was planned is a leading statement
because they may respond affirmatively for fear of criticism if the pregnancy was
unexpected. Rather, encourage the parents to state their true reactions by referring to
specific facts relating to the pregnancy, such as the spacing between offspring, an
extended or short interval between marriage and conception, or a pregnancy during
adolescence.

Dietary History- Parental concerns are common, and nursing interventions are
important in ensuring optimum nutrition.

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Allergies- Ask about the commonly known allergy disorder like
drug,latex,food,animals etc.

Immunization-A record of all immunizations is essential. As many parents are

unaware of the exact name and date of each immunization, sources of information
include the child's health care provider, school record, and the state's centralized
immunization registry. All child should be screened for contraindications and
precautions before any vaccine administered.

Habits-in habits we can explore regarding the behaviour pattern like nail biting,
pica, thumb sucking,unusual movement,use of alcohol,drugs,coffee or
tobacco,activitaminies of daily living etc.

Growth and development- In this growth we need to assess the height , weight,
head circumference, MUAC etc. We need to check for the growth pattern in the
growth chart and check for any significant deviation from the normal.

For development we need to assess the milestone achievement time egs. When the
baby hold the neck,when he started walking without assistance etc.

Reproductive Health History

Reproductive health history is an essential component of adolescents' health

assessment. The history uncovers areas of concern related to sexual activity, alerts
the nurse to circumstances that may indicate screening for sexually transmitted
infections or testing for pregnancy and provides information related to the need for
reproductive health counseling, such as safer sex practices.

The approach to initiating a conversation about reproductive health concerns is to

begin with a history of peer interactions and Open- ended statements .

Family Health History

The family health history is used primarily to discover any genetic or chronic
diseases affecting the child's family members.

Assess for the presence or absence of consanguinity (if anyone in the family is
related to their spouse's/partner's family).

Family health history is generally confined to first-degree relatives (parents,

siblings, grandparents, and immediate aunts and uncles). Information includes age,
marital status, health status, cause of death if deceased, and any evidence of
conditions, such as early heart disease, stroke, hypertension, cancer, diabetes
mellitus, obesity, congenital anomalies, allergies, asthma, seizures, tuberculosis.

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abnormal bleeding, hearing or visual deficits, and psychiatric disorders . Confirm
the accuracy of the reported disorders by inquiring about the symptoms, course
treatment of each diagnosis.

Geographic Location- for the identification of possible exposure to endemic diseases

or vector-borne diseases, such as those from mosquitoes or ticks in warm and humid
or heavily wooded regions.

Family assessment-collection of data about composition of family members and

relationship among them.

Psycho-social history - The traditional medical history includes a personal and

social section that concentrates on children's personal status, such as school
adjustment and any unusual habits, and the family and home environment.

Review of system-The review of systems is a specific review of each body system,

following an order similar to that of the physical examination

Constitutional: Overall state of health fatigue recent or unexplained weight gain or

loss (period of time for either),contributing factors, exercise tolerance ,fever.

Specific: like - Neck Pain, limitation of movement, stiffness, difficulty in holding the
head straight (torticollis), thyroid enlargement enlarged nodes or other masses.

Respiratory: Chronic cough wheezing, shortness of breath at rest or on exertion,

difficulty breathing, snoring, sputum production infections (pneumonia.
tuberculosis), and skin reaction from tuberculin testing.

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 NUTRITIONAL ASSESSMENT

Introduction- Nutritional assessment allows healthcare providers to systematically

assess the overall nutritional status of patients, diagnose malnutrition, identify
underlying pathologies that lead to malnutrition, and plan necessary interventions.

While performing nutritional assessment, it is important to understand that there is

no single best test to evaluate nutritional status. Information should be collected
systematically, and an evaluation of nutritional status should be done based on the
overall data collected.

Definitions-

Nutritional assessment is the systematic process of collecting and interpreting

information in order to make decisions about the nature and cause of nutrition
related health issues that affect an individual (British Dietetic
Association (BDA), 2012).

As per the American Society for Parenteral and Enteral Nutrition (ASPEN)
guidelines, a comprehensive nutritional assessment involves a thorough clinical
examination (history and physical examination), anthropometric measurements,
diagnostic tests, and dietary assessments.

Purpose -

 Estimate the dietary intake,functional status,body composition compared to

normal population.
 Body composition reflects calorie and protein needs.
 Nutritional status predicts the hospital morbidity, mortality, length of stay,cost
 Baseline body composition and biochemical markers determines if nutrition
support is effective.

Methods of nutritional assessment-

Nutrition is assessed by two types of methods

1. Direct methods-deals with individual and measure objective criteria.

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2. Indirect methods-use community health indices that reflects nutritional
influences.

I.Direct methods-

 Anthropometric methods
 Biochemical, laboratory methods
 Clinical assessment
 Dietary evaluation

II. Indirect methods-

 Culture and social habits.

 vital statistics: mortality, morbidity,and other health indicator like infant
mortality rate under five mortality rate, utilization of maternal and child health
services etc.

ANTHROMETRIC METHODS :

 Anthropos - “man” and metron “ measurement”

 Non invasive technique ,universally applicable,inexpensive and reflects the
current nutritional status .
 Used to evaluate both under and over nutrition.

Parameters of anthropometry :

Age dependent factors:

a) Weight
b) Stature- length or height
c) Head circumference
d) Chest circumference
e) Waist circumference
f) Hip circumference

Age independent factors:

a) Mid upper arm circumference (1-5years)

b) Weight for age
c) Height for age

Weight measurement-

Weight is defined as measurement of total body weight.

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Recording weight:

 The scale should be at the eye level so that the weight can be read accurately and
easily.
 Adjust the scale to zero before each weight is taken.
 Take the measurement with minimum of clothing , without diaper and without
shoes.
 Read the weight from a distance of one foot with the eye vertically at level with
the dial.
 Take the reading to the nearest marking. In case the weight coincides with a
division on the dial, read the exact weight. In case the weight is between the two
divisions take the higher division as the weight.
 Record the weight clearly in the appropriate columns in the register.

Formula for weight according to age-

Age Weight (Kg)

Birth 2.5- 3.3 Kg
3-12 Age (Month) + 9
months 2
1-6 years Age (years) x 2+8
Kg
7-12 years (Age (years) x 7) -5
2
>12 years height in CM-100

Formula for weight for age -

weight of child × 100

Weight of normal child of same age

Interpertation-

The grade of malnourished

>80% - normal

71%-80% -grade I malnourished

61-70% -grade II malnourished

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51-60% -grade III malnourished

< 50 %- grade IV malnourished

General rule for weight

 Newborn weight is 2.7 to 3.3 Kg ( Average is 2.5 Kg )
 First 0 – 7 days 10% of Birth weight will loss
 10th day after birth lost weight is regained
 5 – 6 birth weight will doubled.
 1 year birth weight will be tripled.
 There after 2.2 Kg / year weight gain may occur.
 2½ Year birth weight will be Quadrupled.
 Normal range of weight is (5th, 95th percent)

LENGTH :-
For child less than 2 years we measured the length. Measuring the child lying down
always gives readings greater than the child’s actual height by 1-2 cm. Length is
measured using an infantometer with a fixed head piece and horizontal backboard,
and an adjustable foot piece.
The recorder supports the child’s head while the examiner positions the feet and
ensures that the head lies in the Frankfort horizontal plane .

Apply gentle traction to bring the top of the head in contact with the fixed headpiece.
Secure the child’s head in the proper alignment by lightly cupping the palms of your
hands over the ears. Align the child’s legs by placing one hand gently but with mild
pressure over the knees. With the other hand, slide the foot piece to rest firmly at the
child’s heels. The toes must point directly upward with both soles of the feet flexed
perpendicular against the acrylic foot piece

HEIGHT:

This is measured with the child or adult in a standing position (usually children who
are two years old or more).
The head should be in the Frankfurt position (a position where the line passing
from the external ear hole to the lower eye lid is parallel to the floor) during
measurement, and the shoulders, buttocks and the heels should touch the vertical
stand.
Either a stadiometer or a portable anthropometer can be used for measuring recorded
to the nearest millimetre.

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Formula for age appropriate height -

Age Height (Cms)

At birth 50
At one year 75 (50% of birth height
increased)
At two years 87 (25% 0f birth height
increased)
2-12 years Age(year)X6+77 Or
Age(year)X7+66
Future Girls = Ht at 2 yrs x 2
Adult height Boys =Ht at 2½ yrs x 2

General instruction for height

 Normal newborn birht height is 50 cms (20”) + 2 cms
 First 6 months height gain is 2.5 cms / month
 Later 6 months height gain is 1.25 cms / month
 At 1 year height increases 50% of birth height
 At 2 years increases 25% of birth height
 At 3 years increases 12.5% of birth height
 At 4 years increase 6.25% of birth height
 Birth height doubles at 4 years (100cm)
 13 years - Birth height triples
 Normal range of height is (5th, 95th percent)

C)RAO’S INDEX OR BODY MASS INDEX : The international standard for

assessing body size in adults is the body mass index (BMI).
 Body mass index remains constant up to 5 years of age. Evidence shows that high
BMI (obesity level) is associated with type 2 diabetes & high risk of
cardiovascular morbidity & mortality.

Interpretation of BMI-

BMI range Description

BMI < 15 kg/m2 Malnourished
BMI < 18.5 kg/m2 Under Weight
BMI 18.5-24.5 Healthy weight range
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kg/m Overweight (grade 1 obesity)
BMI 25-30 kg/m2 Obese (grade 2 obesity)

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 BMI >30-40 kg/m2 Very obese (morbid or grade 3
BMI >40 kg/m2 obesity)

D)HEAD, CHEST AND ABDOMINAL CIRCUMFERENCE:

4a). Head Circumference (occipito-frontal circumference (OFC)):

 Head circumference has important diagnosis significance in the first few years.
 Taken with a steel or plastic tape measured at the maximum circumference
around the glabellas and supra-orbital ridges and the occipital protuberance.
 The tape is passed over the stretchable bridge in front and that past of the occiput
which gives the maximum diameter.

General instructions for Head Circumference :

 Newborn head circumference is 35 cms ( 1.25 to 2.5 cms > Chest
Circumference)
 0 – 3 months head circumference increases for 2 cms / month
 3 – 12 months head circumference increases for by 2 cms / 3 months
 1 – 3 years head circumference increases for 1 cm / 6 month (Equals chest
circumference 1 yr)
 3 – 5 years head circumference increases for by 1 cm / year
 5 – 6 year head circumference increases is at adult head size
 Head circumference equals chest circumference by 8-12 months on average 10
months
 Head circumference cross chest circumference by 1 year
 Delay indicates malnutrition
 Normal range of head circumference (5th, 90th percent)
 Head circumference should be measured until 3 years
Formula for calculating head circumference: Head circumference = {Length (cm)
+ 9.5}/2
Table : Age appropriate head circumference:

Age Centimeter
Birth 33-37 cm
(average 35)
3 months: 41cm
6 months 43cm
1 year 47cm
2 years 49 cm
3 years 50.4cm
7 years 49 cm
15 years 55 cm

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4b) Chest circumference:
 Non stretchable tapes (Metal tapes fiber glass tapes and ideal). Cloth tapes are
inaccurate as they strict with continued use.
 Tape laid stretched on the measuring board with reverse side upwards.
 Child put on the reversed tape on the measuring board.
 Tape passed through nipple line.
 Tape should surround the chest is above mentioned plane.
 Measurement is done at the end of expiration.
 Measured in recumbent position up to age of 5 years and with standing thereafter
 Record to the nearest 0.1 cm.
 Take three measurement and take mean (average ) of them.

Table : Age appropriate chest circumference

Age Centimeter
Birth 31-35 cm
(average 33)
6 months 39cm
1 year 47cm
2 years 50cm
5years 55cm
10 years 64 cm
15years 77cm

Thumb rule of chest circumference:

 Newborn chest circumference is 33 cms at birth and barrel shaped
 At 1 year Transverse diameter more than anterio posterior diameter by 25 %
 At 6 years transverse diameter more than anterio posterior diameter by 33 %
 At 1 year chest circumference is 47 cms (Equals to head circumference)

4c) Abdominal circumference: It will be same as that of the chest circumference.

Crown-to-rump measurement: It is 31-35 cm (12.5 to 14 inches)

(E)MID ARM CIRCUMFERENCE (MAC):

 Mid arm circumference in defined as a treatments of circumference of middle of
the arm mid way between the acromian and the olecranon process (tip of elbow).
Non stretchable measuring tapes or Shakir tape are used to check mid arm
circumference.
 MAC gives useful information conforming the nutritional status of young
children in communities.
 This is also a screening procedure for children who are at risk in rural areas.

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 The measurement is conventionally done on the left side when the arm is kept
hanging by the side of the trunk.
 Midpoint of arm is first determined i.e. the midpoint between the acromion and
olecranon process of ulna bone.
 At the midpoint the circumference is measured by passing the tape around the
arm in that plane.
 Recorded to the nearest 0.1 cm.
 Take three measurement and take the average of the values.


Figure X-X: Shakir tape (0-25 cm length)

Table : Interpretation of values from Sakir tape:

Range Interpretation
13.5 – 17 cm (Green) Normal
12.5 – 13.4 cm (Yellow to Mid malnutrition
green)) at risk
11.5-12.4 cm ( Yellow) Moderate
malnutrition
<11.5- (Red) Severe
malnutrition

General instruction for mid arm circumference:

 Newborn mid arm circumference is 11 to12 cm and at one year it is 12 to 16 cm.
later it increases 0.25cm per year. MAC is constant between 1-5 of age among
healthy children.

Table - Mid arm circumference at age

Age MAC in cm
At birth 11-12
1 year 12-16
1-5 years 16-17
5-12 years 17-18
12 to 15 18 to 21
years

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(F)SKIN FOLD THICKNESS:
 Skin fold thickness is defined as a measurement of subcutaneous fat taken by
measuring a fold of skin running parallel to the length of the arm over the triceps
muscle midway between the acoromion and the olecranon process. Used as
means of estimating percentage of body fat.
 Harpenden’s calipers or Ross adipometer are used to assess skin fold thickness.
 With child’s right arm flexed 90º at elbow mark midpoint, on posterior aspect of
the arm.
 With the arm hanging freely, grasp a fold of skin between thumb and fore finger
1 cm above midpoint.
 Gently pull fold away from underling muscle and continue to hold until
measurement is completed.
 Place caliper jaw over skin fold at mid point mark if a plastic caliper in used
apply pressure with thumb to align lines of caliper follow directions for using
other caliper.
 Estimate reading to nearest 1 mm.
 Take measurement until. Duplicate agree within 1 mm.
Interpretation according to Tanner’s chart

Range Interpretation
<90% Subnormal
80-90% Mild malnutrition
60-80% Moderate
<60% malnutrition
Severe
malnutrition

(G) WAIST AND HIP RATIO:

7a) Waist circumference:

 Waist circumference is measured at the level of the umbilicus to the nearest 0.5
cm.
 The subject stands erect with relaxed abdominal muscles, arms at the side, and
feet together.
 The measurement should be taken at the end of a normal expiration.
 Waist circumference predicts mortality better than any other anthropometric
measurement.

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 It has been proposed that waist measurement alone can be used to assess obesity,
and two levels of risk have been identified.
 Level 1 is the maximum acceptable waist circumference irrespective of the adult
age and there should be no further weight gain.
 Level 2 denotes obesity and requires weight management to reduce the risk of
type 2 diabetes & CVS complications.

Level Males Females

Level- > >80cm
1 94cm
Level- >102cm >88cm
2
Table : levels of risk for obesity

7c). Hip circumference:

 Is measured at the point of greatest circumference around hips & buttocks to the
nearest 0.5 cm.
 The subject should be standing and the measurer should squat beside him.
 Both measurements should taken with a flexible, non-stretchable tape in close
contact with the skin, but without indenting the soft tissue.

Interpretation of waist hip rations (WHR):

 High risk WHR= >0.80 for females & >0.95 for males i.e. waist measurement
>80% of hip measurement for women and >95% for men indicates central (upper
body) obesity and is considered high risk for diabetes & CVS disorders.
 A WHR below these cut-off levels is considered low risk.

(H) ADVANCED BODY COMPOSITION ANALYSIS

Advanced body composition analysis is a set of advanced techniques that provide
various measurements including total body fat, muscle mass percentages, bone
weight, and visceral adipose tissue (VAT) score among other measurements of body
composition. Methods may include the following:
a. Dual-energy X-ray absorptiometry (DEXA).
b. Underwater (hydro-static) weighing / hydro- densitometry.
c. Air displacement plethysmography (ADP).
d. Bio-electrical impedance analysis (BIA).

Normal Wasted Stunted

Weight for age % 100 70 70
Weight for height 100 70 100
%
Height for age % 100 100 84

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Biochemical assessement:

biochemical assessment means checking levels of nutrients in persons’ blood ,urine

and stool. Lab test give useful information about medical problems that may affect
appetite or nutritional status.

Clinical assessment-

A significant amount of information regarding nutritional deficiencies comes from a

clinical examination, especially from assessing the skin, hair, teeth, gums, lips,
tongue, and eyes. Hair, skin, and mouth are vulnerable because of the rapid turnover
of epithelial and mucosal tissue Few are diagnostic for a specific nutrient, and if
suspicious signs are found, they must be confirmed with dietary and biochemical
data.

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Evidence of adequate Evidence of Deficiency or excess
nutrition deficient or excess
nutrition
General growth Protien,calories,fats
and other essential
Normal growth Weight loss or poor nutrients especially
velocity,weight gain ,head weight gain, growth vitamin A,Ca,I,Mn.
growth for age failure.
Excess calories.
Excess weight gain
Skin hardening and vitamin A
scaling
Smooth,slightly dry to Excess niacin
touch Seborrheic
dermatitis Riboflavin
Elastic and frim
Dry, rough, vitamin c
Absence of lesion petechiae

Dealyed wound
healing
Hair Stringy,friable,dull,d Protein,calories
ry,thin
Lustrous,silky,strong, Protein ,calorie,Zn
alopecia,
elastic
Depigmentation
Protein,calories,coppe
Raised areas around r
hair follicles

vitamin c
Head Softening of cranial vitamin d
bone,prominence of
Even molding,occipital frontal bone,delayed
prominence,symmetric fusion of sutures
facial features
headache
Excess thiamine
Neck

Thyroid not visible, Thyroid iodine

palpable in midline enlarged,may be
grossly visible

Eyes

Clear, bright Harding and scaling vitamin a

of conjunctiva
Good night vision
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Night blindness
Conjuntiva -pink,glossy vitamin a
Dietary evaluation (assessment)-

Comprehensive evaluation of a persons food intake .

This techniques range from food records to questionnaires and biological makers.

Purpose of dietary assessment-

 To improve the diet of people at household level particularly to improve diets or

feeding of young child , pregnant lady, lactating mothers.
 For planning of national food strategies especially in food crisis.
 As a research purpose to assess the effect of nutrition education programme.

Methods of dietary assessment-

 24 hours dietary recall

 Food frequency questionnaire
 Dietary history since early life
 Food dairy technique
 Observed food consumption

The Dietary Reference Intakes (DRIs) are a set of four evidence based nutrient
reference values that provide quantitative estimates of nutrient intake for use in
assessing and planning dietary intake (US Department of Agriculture, National
Agricultural Library, 2014) The specific DRIs are as follows:

Estimated average requirement (EAR): Estimated to meet the nutrient

requirement of half of healthy individuals for a specific age and gender group.

Recommended dietary allowance (RDA): Sufficient to meet the nutrient

requirement of nearly all healthy individuals for a specific and gender group .

Adequate intake (AI): Based on estimates of nutrient intake by healthy individuals.

Tolerable upper intake level (UL): Highest nutrient intake level likely

to pose no risk of adverse health effects.

The detail dietary history should be collected according to child age. In general ,
younger the child is more specific and detailed history should be collected.

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 FAMILY ASSESSMENT

Meaning of family assessment-

Family assessment is the collection of data about the family composition and the
bond share by its members . by this we get to know about the strength and weakness
,needs , available resources that affect a child’s safety, and well being.

Purpose of family assessment-

Understand the child’s needs.

Gather the important information about the child

Analyses the level of risk the child is facing.

Support the family to build on strengths.

Improve the child outcome.

Offer the required services from parenting programmes,NGOs etc.

Methods-

The most common methods of collecting information on family structure is to

interview family members.

General guidelines-

 Schedule the interview with the family at a time that is most convenient for all
the parties, include as many family members as possible clearly state the

purpose of the interview.

 Begin the interview by asking each person's name and their relationships to one
another
 Restate the purpose of the interview and the objective
 Keep the initial conversation general to put members at ease and to learn the "big
picture" of the family.

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 Identify the major concerns and reflect these back to the family to be certain that
all parties receive the same message
 Terminate the interview with a summary of what was discussed and a plan for
additional sessions if needed

Structural Assessment Areas

Family Composition

⚫ Immediate members of the household (names, ages, and relationships)

 Significant extended family members

 Previous marriages, separations, death of spouses, or divorces

Home and Community Environment

⚫ Type of dwelling, number of rooms, occupants

⚫Sleeping arrangements

 Number of floors, accessibility of stairs and elevators.

 Adequacy of utilities
 Safety features (fire escape, smoke and carbon monoxide detectors, guard-rails
on windows, use of car restraint)
 Environmental hazards (e.g., chipped paint, poor sanitation, pollution, heavy
street traffic)
 Relation with neighbour

Occupation and Education of Family Members

 Types of employment

 Work schedules

 Work satisfaction
 Exposure to environmental or industrial hazards
 Sources of income and adequacy
 Effect of illness on financial status
 Highest degree or grade level attained

Cultural and Religious Traditions

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 Religious beliefs and practices
 Cultural and ethnic beliefs and practices
 Language spoken in home

Functional Assessment Areas:

Family Interactions and Roles

 Interactions refer to ways family members relate to each other. The chief concern
is the amount of intimacy and closeness among the members, especially spouses
 Roles refer to behaviors of people as they assume a different status or position

Power, Decision-Making, and Problem-Solving-

 Power refers to individual member's control over others in family, it is

manifested through family decision-making and problem-solving.
 Chief concern is clarity of boundaries of power between parents and children
 One method of assessment involves offering a hypothetical conflict or problem
such as a child failing school and asking family how they would handle this
situation.

Communication

 Communication is concerned with clarity and directness of communication

patterns .
 Further assessment includes periodically asking family members if they
understood what was just said and to repeat the message

Expression of Feelings and Individuality-

 Expressions are concerned with personal space and freedom to grow, with limits
and structure needed for guidance
 Observing patterns of communication offers clues to how freely feelings are
expressed.

ROLE OF NURSE IN FAMILY ASSESSMENT

During the family assessment, the role of nurse is to gather information relating to:

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 The child’s developmental needs: It covers self-care skills, social presentation,
family and social relationships, identity emotional and behavioral development,
education and health.
 Parents or carers capacity to respond to those needs: The specific components of
parenting capacity are basic care, ensuring safety, emotional warmth, stimulation,
guidance and boundaries and stability.
 The impact of wider family and environmental factors on both the child’s
development and parenting capacity specifically: community resources, the family’s
social integration, income, employment, housing, wider family, family history and
functioning.
 Seeing and interviewing the children: Professional nurses should make every effort
to see the child on their own. The interviews should minimise distress for the child
and enable them to open up. Nurses must avoid asking leading or suggestive
questions. They also need to spend time building a relationship, listening to and
respecting the child’s views, explaining the assessment process, and enabling them
to make choices where possible.

 Interviewing parents and/or carers individually; whole family assessments and

observations of parent- child interaction in a number of settings and at different
times of the day. The relationships between parents and each child in the family
should be considered individually, as parents may be able to provide adequate care
for one child but not for another. It is important not to ignore the role and influence
of fathers within the family, even if they are not currently living with their children.
Assessments also need to construct a family history, particularly any previous
involvement with social services and the outcomes of this involvement for the child.

 Nurse notes down, how the family interacts with her and with each other.

 She becomes vigilant to find out signs of family disunity, poor communication,
inflexibility, and animosity between the adults. As these features of family
functioning are strong indicators of a number of different types of child
maltreatment
 Nurse has to coordinate the involvement of other professionals in the process like
speech and language therapists, child psychologists and drug and alcohol counsellors
etc.

Research article:

1. Impact of a home-based nutritional intervention program on nutritional

status of preschool children: a cluster randomized controlled trial

Ansuya B et al. BMC Public Health. 2023.

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Background: Under nutrition in under-five children remains a worldwide health
issue and is considered one of the leading causes of increased morbidity and
mortality. This study aims to assess the impact of home-based nutritional
intervention on the nutritional status of preschool children living in rural areas of
South India.

Methods: A single-blinded cluster randomized controlled trial evaluated the impact

of the intervention, with weight gain as the primary outcome. A cluster of 12
villages was randomized to intervention or control arms. A total of 253 underweight
preschool children from 12 clusters (villages) were randomized to intervention (n =
127) and control arm (n = 126). The intervention was composed of a health-teaching
program and a demonstration of nutritious food preparation in addition to the regular
services provided at the Anganwadi centers. The control arm received only standard
routine care provided in the Anganwadi centre. The anthropometric assessment was
carried out at the baseline and every month for a year.

Result: A significant increase in the mean weight kilograms was noted in the
intervention group (11.9 ± 0.98 to 13.78 ± 0.89) compared to the control group (11.8
± 1.03 to 12.96 ± 0.88). In the intervention group, at the baseline, 41.5% were
moderately malnourished (> - 2SD-3SD), which decreased to 24% at the end of the
year. Similarly, severe malnutrition decreased from 8.69 to 3.16%, while 20.5% of
malnourished children achieved normal nutritional status. In the control group,
undernourished children demonstrated minimal changes in nutritional status.
Analysis of repeated measures of ANOVA results between the intervention and
control groups on weight measurements (F (1, 251) = 15.42, p .001) and height
measurements (F (2, 1258) = 1.540, p .001) revealed statistical significance.

Conclusion: The nutritional status of preschool children is found to be improved by

home-based intervention, which includes training mothers or caregivers in planning
and preparing healthy nutritious diets, providing timely care, and gaining an
understanding and knowledge of the nutritional status along with regular home based
diet preparation.

2. Assessment of Nutritional Status of Under-Five Children in an Urban Area

of South Delhi, India

Mohit Goyal , Nidhi Singh , Richa Kapoor , Anita Verma , Pratima Gedam

Introduction: Malnutrition among children continues to be a severe public health

problem worldwide, whether in a developing country like India or a developed
nation. Correct estimation of the problem is a prerequisite to planning the measures
to control it.

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 Objective :To estimate the prevalence of undernutrition among children under five
years of age by utilizing the Composite Index of Anthropometric Failure and the
WHO growth charts.

Methods :From January to March 2020, 1332 children under the age of five years
participated in a facility-based, descriptive, cross-sectional study at Fatehpur Beri,
Urban Primary Health Center. An anthropometric assessment for each participant
was done as per the WHO criteria. The data were entered into a Microsoft Office
Excel spreadsheet (Microsoft Corporation, Redmond, WA) and analyzed with WHO
Anthro software (WHO, Geneva, Switzerland) and a licensed version of SPSS 21
(IBM Corp., Armonk, NY). Continuous data were expressed using appropriate
measures of central tendency, while categorical data were expressed in either
frequency or proportions.

Results :The mean age of the study participants was 23.04 ± 18.24 months, and
males (53.3%) were more than (46.7%) females. The prevalence of being
underweight was 24.5% (327/1332), of which 24.1% (79/327) of children were
severely underweight. Of the total study participants, 27.3% (362/1332) were
stunted, and 17.8% (237/1332) were wasted, of which 29.1% (69/237) were severely
wasted. The prevalence of anthropometric failure was 45%.

Conclusions :According to the findings of this study, the prevalence of

undernutrition among the study participants was substantial. Furthermore,
considering weight for age as the sole criterion may underestimate the true
prevalence of malnutrition. The findings have critical implications for future
interventions and initiatives among children in India.

3.Assessment of parental awareness about pediatric visual problems by

Knowledge-Attitude-Practice survey in South India

Neelam Pawar,Meenakshi Ravindran,Allapitchai Fathima,K Ramakrishnan,Sabyasachi

Chakrabarthy,K Aparna,Mohammed Sithiq Uduman

Purpose: To find out parents' knowledge, attitude, and treatment practice (KAP)
toward pediatric eye problems and to assess the effect of demographic factors such
as gender, age, educational status, and number of children on KAP.

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Methods: A cross-sectional descriptive study was conducted in a hospital setting.
Two hundred parents were randomly selected for the questionnaire. All parents had
children who were included in Systematic Pediatric Eye Care Through Sibling
Screening Strategies (SPECSSS) study. A survey with 15 questions on KAP of
pediatric eye diseases was prepared and administered to parents coming to a tertiary
eye hospital with varied experience and education qualifications.

Results: The mean age of 200 patients was 9.6 (3.4) years, with the majority of them
male (n = 110; 55.0%). The majority of the children (n = 91, 45.5%) were between
the age group of 6-10 years. Knowledge of visual problems among parents was of a
good grade in 9% only. The attitude of the parents toward the visual problem was
positive at 17%, and the responses regarding the practice were of excellent grade at
46.5% and good at 26.5%. Analysis suggests that the level of knowledge and
practice were not significantly associated with the demographic factors (p > 0.05).
The positive attitude toward the visual problems of the children was associated with
education of the parents (p < 0.05) and the father occupation (p < 0.05).

Conclusion: Knowledge about pediatric eye diseases was poor among parents and it
was significantly affected by education and occupation of parents. The parents have
positive attitude toward enhancing their attitude in treatment.

SUMMARY - In today's seminar we discussed about the history taking , nutritional

assessment , family assessment their purpose and methods.

CONCLUSION- History taking and nutritional assessment are very essential part of
the medical field activity . they provide the core information about the child to
provide the holistic care .every part of history collection, nutritional assessment and

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family assessment is important and thoughtful. By family assessment we find out
how there family and its environment effect the child health.

BIBLIOGRAPHY-

1. Hockenberry, M. J., & Wilson, D.,Rodgers,C.C. (2013). Wong’s essentials of

pediatric nursing (3rd South Asian ed.). Missouri: Elsevier. [Pg-136-145]

2. Marlow, Dorothy R., and Barbara A. Redding. Textbook of Pediatric Nursing .

South Asian, Elsevier. [Pg-57-58]

3. Kyle, Terri & Carman, Susan. (2022). Essentials of Pediatric Nursing 2nd
Edition:Wolters Kluwer / Lippincott Williams & Wilkins. [Pg-274]

4. Nutritional Assessment - BAPEN

https://www.bapen.org.uk/nutrition-support/assessment-and-planning/nutritional-
assessment
5. https://www.ncbi.nlm.nih.gov/books/NBK580496/

6. B A, Nayak BS, B U, N R, N SY, Mundkur SC. Impact of a home-based

nutritional intervention program on nutritional status of preschool children: a
cluster randomized controlled trial. BMC Public Health 2023;23:51.
https://doi.org/10.1186/s12889-022-14900-4.

7. Goyal M, Singh N, Kapoor R, Verma A, Gedam P. Assessment of Nutritional

Status of Under-Five Children in an Urban Area of South Delhi, India. Cureus
2023. https://doi.org/10.7759/cureus.34924.

8. Pawar N, Ravindran M, Fathima A, Ramakrishnan K, Chakrabarthy S, Aparna

K, et al. Assessment of parental awareness about pediatric visual problems by
Knowledge-Attitude-Practice survey in South India. Indian Journal of
Ophthalmology 2023;71:2175–80. https://doi.org/10.4103/IJO.IJO_2717_22.

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