General
                      Paediatric Nutrition 
                                     and Dietetics
                                            Rowan Stewart APD
         Introduction                                                   i
    Special Acknowledgements
    The support of the dietitians who have contributed to Paediatric Nutrition and Dietetics is warmly 
    acknowledged. Special thanks goes to Kathy Beck for the thought and insight she dedicated to the book's 
    format and for her collaboration, support and help in bringing our team of experts together. Thank you 
    to Melissa Gilroy for her contributions, suggestions and direction. Thanks goes to Sally McCray, (Director 
    Nutrition and Dietetics at Mater Health Services, Mater Children's and Mater Children's Private Hospital, 
    Brisbane) and Dr. Robyn Littlewood (Director, Nutrition and Dietetics Department, Royal Children's 
    Hospital, Brisbane) for their ongoing support of this project. 
    Recognition must also be given to the people who contributed to the design and format. Thank you to 
    Eric Liu who demonstrated persistence and patience whilst working on the design and to Nicole Simpson, 
    Genna Ravizza and Jennifer Hall as proofreaders.
    Final thanks goes to Hume, Grace and Olivia Campbell to whom the book is dedicated.
    For Health Professionals
    Paediatric Nutrition and Dietetics provides information about general paediatric conditions requiring 
    nutritional intervention. The editor, authors, contributors and reviewers of the text have endeavoured to 
    provide accurate and up-to-date information, however, it is recommended that judicious professional 
    assessment be applied when using this resource. The editor accepts no responsibility for omissions or 
    inaccuracies in the content of Paediatric Nutrition and Dietetics, nor the clinical decisions made by health 
    professionals applying the information in this text. Users are advised to confirm that the information here 
    complies with recent changes in evidence and protocol. Medical reference ranges vary between hospitals 
    and clinical practices. It is advised that clinicians follow the protocol at their locality.
    Australian Publishing 
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      Australia
      Tel: +61 (0)7 3852 0923
    All rights reserved. No part of Paediatric Nutrition and Dietetics may be reproduced, electronically 
    transmitted, photocopied, stored in computer retrieval networks, or used in any form, without the editor’s 
    permission. To contact, Rowan Stewart, please go to australiandietitian.com.
    First edition printed in 2012
    ISBN 978-0-9805086-4-2
    Set in Museo Sans by Eric Liu — Communication and Design
    Printed and bound in Brisbane, Australia by Kingswood Press
    The editor's policy is to use printers who embrace the Sustainable Green Print (SGP) program. 
    ii                                                                Paediatric Nutrition and Dietetics
         Foreword
         It is with great pleasure that I write the foreword for Paediatric Nutrition and Dietetics.
         This book has been created through bringing paediatric experts together to share the 
         most up-to-date information for health professionals and students. It is a follow-on 
         from the widely popular Handbook of Clinical Nutrition and Dietetics 4th Edition, which 
         has assisted dietitians and dietetic students over many years. Now with this new guide, 
         paediatric dietitians, teachers and student dietitians alike have a practical guide which 
         provides comprehensive information on the nutritional management of infants, children 
         and adolescents.
         Paediatric Nutrition and Dietetics contains information on guidelines, protocols and 
         procedures used in the clinical setting meeting the needs of paediatric nutrition health 
         practitioners. In addition to nutrition in the normally developing child, it covers paediatric 
         conditions with the potential to adversely affect growth and development including 
         diabetes, inflammatory bowel disease, coeliac disease, cerebral palsy and cystic fibrosis. 
         It also offers information on adverse food reactions including allergies and intolerances, 
         eosinophilic oesophagitis and FPIES. Sample PES statements are presented for each 
         condition. Complete nutrition profiles of feeds and formulae, for use in infants, children, 
         and adolescents, are included and the companies providing these products to the 
         Australian market have been consulted to ensure profiles are current and accurate. This 
         is the first of two books on paediatric nutrition and dietetics, the second of which is due 
         for release in 2013 and will focus on the nutritional management of more specialised and 
         complex paediatric conditions.
         This addition to the handbook range will be an invaluable tool for novice and experienced 
         dietitians alike and provides a quick, current reference for practitioners to be used in 
         conjunction with more comprehensive texts and information.
         Sally McCray
         Director Nutrition and Dietetics 
         Mater Health Services, Brisbane 
         (Encompassing Mater Children’s and Mater Children’s Private Hospitals)
         Introduction                                                   iii
    Table of Contents
    1  Normal Paediatric Development and Growth
       Nutrition Assessment by Clinical Measure..................................................................................................1
       Developmental Milestones
        1–24 Months .....................................................................................................................................................1
        2 Years ................................................................................................................................................................4
        3 Years ................................................................................................................................................................ 5
        4 Years ................................................................................................................................................................6
        5 Years ................................................................................................................................................................ 7
       Standard Anthropometric Measurements .................................................................................................8
       Growth ...................................................................................................................................................................8
       Growth Charts ......................................................................................................................................................8
       Anthropometric Measurements .......................................................................................................................9
       Length/Height/Stature ......................................................................................................................................10
       Height Prediction Equations ............................................................................................................................11
          Tibial Length ................................................................................................................................................ 12
          Upper-arm Length ..................................................................................................................................... 13
          Knee Height ................................................................................................................................................. 13
       Standard Deviation Scores (Z Scores) ........................................................................................................... 14
       Weight................................................................................................................................................................... 15
       Amputation .......................................................................................................................................................... 16
       Head Circumference ......................................................................................................................................... 17
       Body Mass Index ................................................................................................................................................ 18
       Tricep Skinfolds...................................................................................................................................................20
       Arm-muscle Circumference ...........................................................................................................................20
       Assessing Body Composition ..........................................................................................................................22
       Abdominal Quadrants .......................................................................................................................................22
       References ..........................................................................................................................................................23
    iv                                                          Paediatric Nutrition and Dietetics