A thorough dietary assessment is the first step in looking at potential dietary causes of feeding difficulties, behaviours and physical symptoms. Dietary treatment options and interventions are considered within the context of each individual history, growth and nutritional status as well as the holistic view of which feeding and eating behaviours are part. An allergy focused history is incorporated when food allergy is suspected or is present. For little ones under 1 year of age this may include observing feeding.
Early Feeding History
Depending on the presenting problem, an early feeding history for young children can provide a good explanation of both what is happening now, and helps consider suitable approaches to dietary management going forward. The infant feeding assessment takes a closer look at feeding behaviours, experiences or difficulties a specific stages of their early feeding development. If there are gaps in an infants experiential learning and/or feeding practices due to adverse experience or illness, this can be very helpful to identify. In many instances, it is essential to understand what feeding learning has been missed.
Measurements of growth are usually taken; weight, height, head circumference, and where helpful, waist circumference and calculation of body mass index (or % weight for height). I use UK-WHO 1990 growth charts, which provide a comparison with infants and children of the same age and sex; and a way to monitor growth over time for each child. Used as a record of wellbeing and development in infants and young children, this growth time-line can be a helpful way of understanding what impact dietary changes or symptoms are having on growth, particularly where growth faltering in infancy is present. Some young people may have concerns about the growth being measured, and this is always taken into consideration.
Assessing nutritional intake and individual needs
An infant or child nutritional intake us assessed during a guided discussion about what, when and how much food and drink your child is consuming. This provides a good estimate of energy, protein, fluid and nutrient intake of the diet as a whole. Key nutrients for infants and children such as calcium, iron, magnesium, zinc and Vitamins A, C and D are assessed and balance of the essential food groups containing proteins, fats and carbohydrates, fruits, vegetables and snacks an drinks. Assessing individual needs involves making comparisons against age/sex and growth needs and identifies any significant nutrient gaps or excesses.
Sleeping and physical activity, family and school routines as well as family medical background are all relevant within this dietary assessment. Abdominal sensations/symptoms and bowel habits are another key focus. This helps to have as holistic a view of the circumstances as possible. Medical tests results can be helpful, and if indicated may be requested from your GP or specialist service.