Guidelines & References
ASCIA Guidelines - Infant Feeding and Allergy Prevention |
Healthy Eating for Children. 2012. NHMRC |
Infant feeding guidelines summary. 2012. NHMRC. |
Eat for health. Infant feeding guidelines for health workers. 2012. NHMRC |
Assessment Considerations
'Head to toe' assessment |
↑/recurrent illness? |
Energy levels (playing/happy) |
sleep quality |
level of irritability |
appetite |
missed days of school |
Dietary: bottle vs breast, types/texture of food, solids?, quantities of food/formula/feed, fluids offered, allergy exposures, mealtime routine, family restrictions (e.g. culture, other beliefs) |
Growth
Under 2 = weight-length |
Over 2 = BMI → Plot on CDC BMI for age chart |
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Above 95% = obese |
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Above 85% = overweight |
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On 50% = healthy weight |
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Below 5% = underweight |
Weighing |
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Supine (laying down) <24 months |
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Standing or Supine 24-36 months |
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Standing >36 months |
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Minimal clothing, dry nappy (40-50g dry) |
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Take 3 and average (if unsure) |
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Get the parent to hold head |
Nut Reqs (Fluid)
Premature <37 weeks |
150-200ml/kg |
First 10 days |
80-100ml/kg |
0-3 months |
140-160ml/kg |
4-6 months |
130-155ml/kg |
7-12 months |
120-145ml/dkg |
1-3 years |
1000ml/day |
4-8 years |
1200ml/day |
9-13 years |
1500ml/day |
14-18 years |
1500-2000ml/day |
Premature (<37 weeks)
Fenton Growth Chart (<37 weeks) – indication of birth weight, not growth trend |
Once they reach their expected due date = plot on WHO chart |
WHO lengths-weight = use corrected age |
Corrected age = actual age – number of weeks premature (0-2 years) |
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Growth Charts
Track trends in percentiles. |
0-2 years: WHO |
2-18 years: CDC |
Weight-age: general weight status |
Length-age: stunting/short stature |
Weight-length: wasting or underweight <2 years |
Head circumference – normal brain growth <2 years |
Z-Scores
weight-length Z-score growth chart |
diagnose malnutrition (NOT percentiles) |
-1 to -2 = milk malnutrition |
-2 to -3 = moderate malnutrition |
>-3 = severe malnutrition |
Nut Reqs (Birth-2 years, both sex)
Birth-3 months |
100kcal/kg (NO PAL) |
AI: 10g (1.43g) |
6 months |
90 kcal/kg (NO PAL) |
7-12 months |
80-90kcal/kg (NO PAL) |
AI: 14g (1.6g) |
12 – 24 months |
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RDI: 14g (1.08g) |
Nut Reqs (2-18 years, male)
age |
energy |
P |
2-3 years |
0.249 x wt - 0.127 = MJ * PAL |
RDI: 14g (1.08g) |
4-8 years |
0.095 x wt +2.11 = MJ * PAL |
RDI: 20g/day (0.9g) |
9-18 years |
0.074 x wt + 2.754 = MJ * PAL |
40-65g/day |
1 MJ = 238.85 kcal |
Nut Reqs (2-18 years, female)
Age |
EER |
P |
2-3 years |
0.244 x wt – 0.13 = MJ * PAL |
RDI: 14g (1.08g) |
4-8 years |
0.085 x wt +2.033 = MJ * PAL |
RDI: 20g/day (0.9g) |
9-18 years |
0.056 x wt + 2.898 = MJ * PAL |
35-45g/day |
1 MJ = 238.85 kcal |
PAL
For EER, 2-18 years |
1.2 |
Bed rest |
1.4 |
Very sedentary |
1.6 |
Light activity |
1.8 |
Moderate activity |
2.0 |
heavy activity |
2.2 |
Vigorous activity |
Injury Factors
Burns |
1.5-1 |
CF |
1.2 - 1.5 |
Malabsorption |
1.2 - 1.5 |
Minor surgery |
1.2 |
Oncology |
1.3 |
Respiratory (acute) |
1.5 |
Respiratory (chronic) |
1.2 - 1.5 |
Skeletal trauma |
1.35 |
FTT |
1.2 - 1.4 |
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First Foods
0-6 months |
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Exclusively milk/formula. Formula = boiled & cooled water |
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Feed on demand – every 1-2 hour breast. 3-4 hour formula |
4-6 months |
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Introduce solids – purees & milk |
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Start w/ smooth purees high in iron |
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Showing physical signs of ready to eat |
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Introducing allergens |
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Water - can have a bit, but not as a main drink |
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Boiled & cooled water |
7-9 months |
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Soft, lumpy, mashed foods + breast milk |
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Encourage chewing with gums – teeth should be coming through. |
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Trial cup drinking |
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Encourage chewing |
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3 main meals +/- 3-4 breastfeeds a day |
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Boiled & cooled water |
10-12 months |
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Finger foods (big cuts), still soft, but solid |
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3 main meals + 2 smaller snacks + 2-3 breastfeeds a day |
12+ months |
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Concern if not having solids |
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“Parent provide, child decides” |
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Increasing variety of foods and textures |
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Encourage self-feeding |
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Family meals |
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Can have cows milk as a drink |
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Once they are having 3 meals a day = can introduce water as a drink. |
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Can have honey |
Intervention
Paeds malnutrition screening: PNST (repeat every 7 days if at risk) |
Meet energy, protein, calcium, iron, and vitamin D needs |
Encourage structured meal and snack routines |
Prevent development of disordered eating patterns |
Consider: bottle, introduction of solids, feeding stage, fluids?, allergies, supplements |
DDR Prompts
Nutritional gaps during growth can affect energy, mood, immunity, and long-term health. |
Skipping meals, picky eating, or too many ultra-processed foods can lead to deficiencies. |
Strategies
Fussy eating: central mealtimes, eating together at table, messy food play, multiple exposures, offer variety. Educate: exposures → acceptance |
Promote 3 regular meals and 2–3 snacks per day |
Ensure enough protein: eggs, lean meat, legumes, dairy |
Reduce sugary drinks and ultra-processed snacks |
Involve children in shopping and meal prep |
Promote a positive food environment (no pressure, no reward foods) |
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