Risk factors may include
Inability to ingest or digest food or absorb nutrients because of biological, psychological, or economic factors
Increased metabolic demands
Possibly evidenced by
(Not applicable, presence of signs and symptoms establishes an actual diagnosis)
Desired Outcomes/Evaluation Criteria—Child Will
Ingest nutritionally adequate diet for age, activity level, and metabolic demands.
Demonstrate stable weight or progressive weight gain toward goal.
Nursing intervention with rationale:
1. Identify child at risk for malnutrition, such as with intestinal surgery, hypermetabolic states, restricted intake, and/or prior nutritional deficiencies.
Rationale: Provides opportunity for timely intervention.
2. Determine ability to chew, swallow, and taste. Note presence of conditions affecting food intake, such as lactose intolerance, cystic fibrosis, diabetes, inflammatory bowel diseases, or eating disorders.
Rationale: These factors can affect specific dietary choices, desire to eat and/or ingestion and digestion of nutrients.
3. Determine child’s current nutritional status using ageappropriate measurements, including weight and body build, strength, activity level, and sleep and rest cycles.
Rationale: Identifies individual nutritional needs and provides comparative baseline.
4. Auscultate bowel sounds. Note characteristics of stool, including color, amount, and frequency of bowel movements.
Rationale: Provides information about digestion and bowel function and may affect choice and timing of feeding.
5. Elicit information from child/parent regarding typical daily food intake, determining foods and beverages normally consumed. Note types of snacks. Discuss eating habits and food preferences—likes and dislikes.
Rationale: Baseline information to determine adequacy of intake. Knowledge of child’s specific likes and dislikes may be helpful in meeting child’s nutritional needs during a time when appetite is suppressed or child has no interest in food.
6. Determine psychological factors and cultural or religious desires or influences on dietary choices.
Rationale: Dietary beliefs, such as vegetarianism, can affect nutritional intake. Usual ethnic food choices can improve a child’s intake when appetite is poor.
7. Determine whether infant is breast-fed or formula-fed, and note typical pattern of feedings during a 24-hour period. Note type and amounts of solid foods infant or toddler eats.
Rationale: Providing usual and typical feedings is important to infant well-being and early growth.
8. Emphasize importance of well-balanced, nutritious intake. Provide information regarding individual nutritional needs and ways to meet these needs within financial constraints. Avoid arguing over food intake. Provide food without comment.
Rationale: Although nutritious intake is important, arguing over food is counterproductive. Providing age-appropriate guidelines to children as well as to parents or care provider may help them in making healthy choices. Note: Childhood obesity with associated long-term physical and psychological effects is also a potential concern regardless of current weight.
9. Clarify caregiver access to and use of resources, such as food stamps, budget counseling, Women, Infants, and Children (WIC) program, community food bank, and/or other appropriate assistance programs.
Rationale: May be necessary to improve child’s intake and/or availability of food to meet nutritional needs.
10. Establish a nutritional plan that meets individual needs incorporating specific food restrictions and special dietary needs.
Rationale: Corrects or controls underlying causative factors, such as with diabetes, cancer, malabsorption syndrome, and anorexia.