NUTRITION

Rationale
Prerequisites
Competencies
Processes

Rationale
Proper nutrition promotes growth and helps maintain health. Some degree of assessment of nutrition is a component of almost every pediatric medical visit. In patients presenting with abnormal growth, nutritional assessment is central to diagnosis and treatment.

Prerequisites

• The appropriate balance of food groups (e.g., the food pyramid of the United States Department of Agriculture/Department of Health and Human Services).
• Basic science course work on body metabolism, the respective roles of dietary fats, carbohydrates, and protein, and the need for vitamins and minerals.
• The role of nutrition in preventive health (e.g., the National Cholesterol Education Program guidelines for adults).

Competencies

Knowledge

1. Describe the advantages of breastfeeding and describe common difficulties experienced by breastfeeding mothers. (CP)
2. Describe the signs and symptoms of common nutritional deficiencies in infants and children (e.g. iron, vitamin D, fluoride, and inappropriate caloric volume) and how to prevent them. (CP)
3. Identify children with specific or special nutritional needs (e.g. patients with chronic illness, prematurity, abnormal growth patterns, failure to thrive, obesity, or when family risk factors suggest the possibility that nutritional modification will be needed). (CP)
4. Describe nutritional factors that contribute to the development of childhood obesity and to failure to thrive. (CP)
5. Discuss risk factors for the development of cardiac disease and diabetes with families. (U)
6. Describe the endocrine, cardiovascular, and orthopedic consequences of childhood obesity. (M)

Skills

1. Obtain a dietary history in children of different ages that includes the following: (CP):
   
   
   • Infants: type, amount and frequency of breast or formula feeding, solid foods, and dietary supplements (vitamins, iron, fluoride).
   • Toddler/school age child: milk, juice, soda, fast foods, and meal patterns
   • Adolescents: meal patterns, nutritional supplements, milk, juice, soda, alcohol, snacking, and fad diets
     
     
2. Determine the caloric adequacy of an infant's diet. (CP)
3. Provide nutritional advice to families regarding the following: (CP)
   
   
   • Breastfeeding vs. formula feeding
   • Addition of solids to an infant's diet
   • Introduction of cow's milk to an infant's diet
   • Healthy food choices for children and adolescents
   • Exercise and TV or video viewing and their effect on obesity

Processes
All students on the Pediatric Clerkship should see a patient or patients with self or parental concerns or questions about appropriate nutrition (e.g. failure to thrive, questions about breast vs. bottle feeding, questions about switching to formula, when to add solids). This can be in the context of a routine health care supervision visit.

Click here to link to the Clinical Case Scenarios.