Normal nutritional requirements across childhood: Viva

Branch 1: Assessing whether requirements are met

The candidate should recognise that this child is meeting her energy requirement, shown by her weight on the 50th centile, but failing on at least one micronutrient, shown by her iron deficiency anaemia. The key teaching point is that a normal weight does not exclude micronutrient deficiency, and excessive milk intake is a classic cause of iron deficiency in toddlers. [10]

A strong candidate would explain that nutritional assessment combines a diet history, a focused examination and anthropometry, and that the growth chart is the most sensitive test of whether requirements are met. Her weight tracking on the 50th centile shows energy adequacy, but her pallor and anaemia reveal the iron gap. The clinician should never conclude that nutrition is adequate from weight alone. [7]

If the examiner presses on the assessment method, the candidate should describe plotting weight, length and head circumference on WHO growth standards, taking a structured diet history including milk type and volume, and examining for signs of micronutrient deficiency and chronic disease. The diet history here would immediately reveal that 800 millilitres of cow's milk per day is well above the recommended maximum of about 500 millilitres. [10]