Complete comprehensive history and physical exam to assess for underlying etiology for malnutrition.
| Factors |
Evaluate |
| Feeding History |
- Breast Feeding
- Frequency, length, number per day, longest interval between feedings, night vs. day
- Falling asleep at breast, not waking for feeds
- One or both breasts, softer after feeding, use of nipple shield, any pain or difficulty with latch or positioning
- If pumping, how much is produced
- See or hear baby swallow
- Any supplementation of expressed human milk or formula
- Other foods or liquids
- Bottle Feeding
- Frequency, length, amount per feed and per day, longest interval between feedings, night vs. day
- Formula mixing recipe, type, and concentration
- Bottle type, nipple type and size
- Any supplementation to the bottle other than formula
- Food (including solids) or liquids other than human milk or formula (water, juice, thickener, etc.)
- Assess positioning
|
| Indicators of Pharyngeal Swallow Dysfunction |
- Coughing during feeding by mouth
- Wet, “gurgly” vocal quality during or immediately after feeding by mouth
- History of frequent upper respiratory tract infections or illness, unexplained fevers, or pneumonia
- If signs/symptoms are appreciated, infant should be referred for an oral feeding evaluation by a speech-language pathologist. (At CHOP, infant is referred to The Feeding and Swallowing Center).
|
| Reflux |
- Coughing, choking, or gagging with feeds
- Spitting up/vomiting
- Respiratory symptoms with feeding
- Arching, irritability or discomfort with feeds
- Bottle and breast refusal
|
| Social |
- Which caregiver(s) feed the baby (mom or other caregivers)
- Who lives in home? Does mom have help? Is she getting sleep?
- Is caregiver appropriately following baby’s feeding schedule, need help with childcare, and/or receiving WIC and/or SNAP?
- If bottle fed, does family have concerns obtaining formula?
- Breast pump availability and type, if applicable
- Assess for postpartum depression for up to 12 months
- Assess for a history of DHS involvement: “Has your family ever received services through child and youth services?"
- Assess for food insecurity
- Does the parent/guardian understand the action plan/goals, next steps and information provided?
- The hunger vital sign food insecurity questions:
- “Within the past 12 months we worried whether our food would run out before we got money to buy more.”
- “Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.”
|
| Elimination |
- Number of wet diapers/urine output per 24 hours
- Presence of orange or red crystal/powder in diaper
- Number of stool diapers per 24 hours
- Stool appearance (consistency, color)
- Presence of blood or mucus in stool
|
The newborn screen is used to detect a number of inborn errors of metabolism and cystic fibrosis, which can be causes of malnutrition.