3002 Peads- Nutrition support, enteral feeding and refeeding syndrome

A key aim was to increase confidence in developing feeding plans, as this is often an area students find challenging. When assessing a child or adolescent with significant weight loss, a comprehensive nutritional assessment is required. This should include: Growth and weight history, including recent weight loss and changes from normal growth patterns. Anthropometric measurements such as BMI and centile charts. Biochemical investigations including electrolytes, iron status (particularly ferritin), hydration markers, and bone profile measurements. Clinical assessment of hydration, gastrointestinal function, menstrual history where appropriate, medications, and any behaviours such as purging. Dietary assessment, including current intake and duration of inadequate nutrition. For adolescents with severe malnutrition or eating disorders, significant weight loss and prolonged low energy intake increase the risk of refeeding syndrome. Nutritional rehabilitation should therefore be carefully introduced and monitored. Energy requirements are generally based on an ideal or target body weight rather than current weight. Management involves close monitoring of: Weight trends. Electrolytes and biochemical markers. Food and fluid intake. Adherence to the nutrition plan. In eating disorder settings, weight is often measured regularly but kept hidden from the patient to reduce anxiety. Healthcare professionals must also consider behaviours that may interfere with nutritional rehabilitation, such as hiding food, excessive activity, or over-exercising. Observation during and after meals may be necessary to ensure nutritional intake is achieved. Overall, successful nutritional support requires careful assessment, individualised feeding plans, regular monitoring, and consideration of both the medical and psychological aspects of care.

According to NICE guidelines 2017, which anthropometric measurements should be gathered during clinical assessment?

Weight, length, head circumference

Which blood tests may be considered when assessing faltering growth is abnormal and there is no underlying reason?

Mg (Magnesium) & U+Es (Urea and Electrolytes), Zinc & Iron, FBC (Full Blood Count)

Vomiting / possets (posset is…

normal effortless spitting up of a small amount of milk by a baby during or shortly after a feed)

During observation of a feed, what is an important factor to assess?

Is there effective milk transfer? Is the baby feeding well from the bottle?

Normal weight loss usually stops by days ___ to ___, and most babies regain their birth weight by ___ weeks of age.

Normal weight loss usually stops by days 3 to 4, and most babies regain their birth weight by 3 weeks of age.

According to NICE guidelines 2017:

A weight loss of more than ___% of their birth weight requires a clinical assessment and feeding review. Consider a specialist referral if they have not regained their birth weight by __ weeks.

A weight loss of more than 10% of their birth weight requires a clinical assessment and feeding review. Consider a specialist referral if they have not regained their birth weight by 3 weeks.

When should there be a concern?

ALL CORRECT