Master Saurabh s/o Mast Ram is got admitted in Paediatric ward on 31/5/22 and diagnosed to be as Failure to thrive
I assessed the child as part of my routine case study and along with I assessed the nutritional status of the child and prepared a nutritional plan
and given health education regarding nutrition and importance of maintaining diet
Demographic data
Name: Master Saurabh
Age/sex 12 yrs./ Male
C.R. no: 9599
Ward no Paediatric ward
Address: S/o Mast Ram, vill- Wasan P.O –Wasan Teh –Mandi Distt-Mandi(h.p)
Diagnosis Failure to thrive
DOA: 31/5/22
Consultant in charge: Dr. Naag Raj
Present Health history: Patient was occur vomiting after eating from 2 days and take less intake diet and sometimes sleep excessive.All time
get lethargic .
Past health history: Patient was admitted in hospital when he was 3 year old then he suffered from upper respiratory infection.
Birth history: Antenatal period was uneventful. No eclampsia or any other complications. Normal vaginal delivery (institutional)
Birth weight- 2.5 kg. Cried soon after birth. Neonatal period was uneventful. No NICU stay.
Immunization: Immunisation is up to date, done according to national immunisation schedule

Nutrition and dietary history: Child were exclusively breast fed for 6 months. Continued breast feeding along with complimentary feeds up to
2 year. Child follows normal vegetarian diet.
Ht- 158 cm Wt- 26 kg
Family health history: Chid belongs to joint family father, mother, and paternal grandmother. No. of family members - 12. No family history of
diabetes mellitus/ hypertension/ tuberculosis/ stroke/MI
PHYSICAL EXAMINATION:
General appearance : The child is moderately built.
Behavior : Less active and feels very lethargic
Emotional stability :Cool and respond well.
Level of consciousness :Conscious and well oriented.
Vital signs:
Temperature 37 0
C Normal
Pulse 80/ min Normal
Respiratory rate 20/min Normal
Blood pressure 100/74 mm of Hg Normal
Anthropometry

Parameters Patient value Normal Value Remarks
Weight 26KG 50-60 Subnormal
height 158 cm 164-180 normal
BMI 10.7 kg/m2
15-17 Subnormal
Head
circumference
53 cm 50 - 55 cm Normal
Chest
circumference
55 cm 55-60 cm Normal

Normal Average Growth velocity in children
Age Growth velocity
0-4 months 1.0 kg/month (30gm/day)
5-8 month 0.75 kg/month (20gm/day)
9-12 month 0.50 kg/month (15gm/day)
1-3 years 2.25 kg/year
4-9 years 2.75 kg/year
10-18 years 5-6 kg/year
AGE MULTIPLICATION
At birth 2.5 kg- 3.5 kg. Normal Birth weight
At 5 months 2 x birth weight
1 year 3 x birth weight
2 years 4 x birth weight
3 years 5x birth weight
7 years 7 x birth weight

HEAD TO TOE ASSESSMENT
Head- size is normal, no scalp lesions dandruff or pediculosis. Hair color normal and normal distribution.
Hair
luster: absent
Thinning: absent
Sparse: absent
Discolored: absent
Easily plucked: absent
Flag sign: absent
Eyes conjunctiva – whitish. No sign of anaemia present, no icterus, no discharge from eyes, normal visual acuity.
Conjunctiva: pink
Xerosis: absent
Bitot’s spot: absent
Corneal opacity: absent
Night blindness: absent
Ears-Normal, are in alignment with the eyes, no lesion or discharge, hearing is normal.
Nose -Normal nostrils and nasal ridges, no running nose, no nasal septal deviation
Lips and tongue—Lips are normal pink in colour, no pallor. No angular or aphthous stomatitis, no cheilosis or other lesions.
Tongue red (Not beefy red)
Pallia atrophic: absent
Dental caries: absent
Mottled enamel: absent

Neck- Normal range of movement performing.
Goiter enlargement: absent
lymph adenopathy: absent
Throat -Normal. No lesions or pharyngitis, no sore throat or congestion.
Genital area-Neatness and cleanliness maintained. Voiding self.
Bones and skeletal system
Normal muscle mass. No bone deformities
Cranial bossing: absent
Craniotabes:absent
Beading of the ribs:absent
Knock knees:absent
Bow legs:absent
Talipes: absent
Skin
Colour: Pallor
Follicular hyperkeratosis: absent
Mosaic dermatosis: absent
Pellagrous dermatosis: absent
Pavement dermatosis: absent
Mental status-child is conscious and well oriented to time person and place. Looks lethargic and less active .
NUTRITIONAL HEALTH EDUCATION
Nutritional counselling is important responsibility of the nurse to promote the nutritional status of the children and to prevent nutritional
deficiency diseases.

Functions of food: They are mainly body building, energy giving and protection by maintenance and regulation of tissue functions.
Classification of Nutrients:Nutrients are classified as
a) Proteins
b) Fats
c) Carbohydrates
d) Vitamins
e) Minerals
Proteins: The sources of proteins are milk, cheese, liver, fish, meat, eggs, pulses, beans, soya beans
Fats: the sources of fats are butter, ghee, cheese, fish oil, mustard oil, groundnut, coconut oil
Carbohydrates: The sources of carbohydrates are wheat, rice, millet, suji, maize, glucose, fructose, banana, potato, sweet potato.
Vitamins: Fat soluble vitamins - A,D,E and K. Water soluble vitamins - B and C
The sources of vitamins and minerals are green leafy vegetables, eggs, yellow fruits, exposure to sunlight, cereals, nuts, amla, roots and tubers,
citrus fruits like orange, lemon, guava, papaya, liver, fish, milk, meat, legumes, jaggery
Special Considerations
 Teach child healthy food habits like green vegetables and fresh fruits. Give him at least 3 servings of fruit everyday
 Milk provides complete nutrition for your child. Under 5-year-old children should not use skimmed milk to restrict on fat and cholesterol as
they need the extra calories, but grilled and baked foods are always preferable to fried and fatty ones.
 Include 3 meals and two nutritious snacks every day.
 Try to avoid low nutritious food items for your child likes sweet dessert, candies, soft drinks and chips.
 A proper nutritious diet can reduce large number of medical problems. It also increases the stamina of your child. Protein has a very
important role in the diet of the growing child because there is considerable increase in muscular development during these years. The
requirements for essential amino acids are higher for children than adults.
 Don’t restrict your child to a single food item. Encourage him to eat variety of food.
 Vitamins and minerals must be supplemented adequately. Calcium and iron requirements are relatively greater during early childhood.
Deficiency of calcium can affect the bones of growing children. Foods rich in calcium such as milk and milk products, green leafy vegetable
and fish should be included in the diet of children. Balanced diet should include food item rich in calcium.
 Nutritious diet includes leafy green vegetables and fresh fruits. Choose a diet moderates in sugars and low in fat.

DIET PLAN FOR SAMEER FOR ONE DAY
Food Item Ingredients: Quantity/
Amount
Carbohydrate Protein Fat Total
Energy
Milk Milk - 150 ml 12 gm 8 gm 8 gm 152 Kcal
Breakfast Boiled Egg 0 10gm 9gm 121 Kcal
1Apple 25 1gm 0gm 95 kcal
Lunch Chappathi 2 no’s 140Kcal
Rice1/3 cup 80 Kcal
Daal 17gm 3gm 308 Kcal
Dahi150 ml 5gm 5gm 90 kcal
Greenbean Sabji 7 gm 1.8gm .2gm 31kcal

Tea and
Biscuit
Milk 150 ml 12 gm 8 gm 8 gm 100 Kcal
Sugar 20gm 27 0gm 0gm gm
110kccal
Dinner Chappathi2 no’s 140Kcal
Mung Daal 100 gm 25gm 1.2 gm 350kcal
Milk Milk 150 ml 12 gm 8 gm 8 gm 100 Kcal