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43.2.3.4 Nutritional Screening
The nutritional screening is to be accomplished during the basic examination using the following methods:
• Ask questions about dietary practices to identify unusual eating habits (such as pica or extended use of bottle feedings) or diets that are deficient or excessive in one or more food groups.
•Determine quality and quantity of individual diets (e.g., dietary intake, food acceptance, meal patterns, methods of food preparation and preservation, and utilization of food assistance programs like WIC and Texas Food Stamps).
•Conduct a complete physical examination, including an oral screening, paying special attention to general features, such as pallor, apathy, and irritability.
•Obtain accurate height and weight measurements and calculation of BMI as important indices of nutritional status.
•Perform laboratory screenings for anemia (hemoglobin and hematocrit), as indicated.
Risk Factors/Screening for Eating Disorders and Obesity
The risk factors/screening for eating disorders and obesity assessment is to be accomplished in the basic examination, using the following methods:
•Adolescents should be asked about body image and dieting patterns.
•Adolescents should be assessed for organic disease, anorexia nervosa, or bulimia if any of the following are found:
•Weight loss greater than ten percent of previous weight.
•Recurrent dieting when not overweight.
•Use of self-induced emesis, laxatives, starvation, or diuretics to lose weight.
•Distorted body image.
•BMI below the fifth percentile.
•Adolescents should have an in-depth dietary and health assessment to determine psychosocial morbidity and risk for future chronic disease if they have a BMI equal to or greater than the 95th percentile for age and gender.
•Adolescents with a BMI between the 85th and 94th percentile are at risk for becoming overweight. A dietary and health assessment to determine psychosocial morbidity and risk for future chronic disease should be performed on these youth if the following are true:
•Their BMI has increased by two or more units during the previous 12 months.
•There is a family history of premature heart disease, obesity, hypertension, or diabetes mellitus.
•They express concern about their weight.
•They have elevated serum cholesterol levels or blood pressure.
If this assessment is negative, these adolescents should be provided general dietary and exercise counseling and should continue to be monitored annually.
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