PEDIATRIC MALNUTRITION INDICATORS


MICRONUTRIENT EXAM: CLINICAL INTERPRETATION OF NUTRITION FOCUSED PHYSICAL EXAM FINDINGS SIGNS/SYMPTOMS


NAILS (continued) Clubbing


Leukonychia white spots or streaks


Half and half (Lindsay nail)


distal nail is red, pink, or brown , while the proximal nail has dull, whitish appearance


Terry’s nail


large part of nail is opague white, obscuring the lunula, leaving thin band of pink-brown distal nail


Longitudinal melanonychia dark brown or brown-black vertical nail band


Subungual melanoma


brown-black discolorations of the nail bed, often on thumb, big toe, or index finger


Pitting


SKIN Delayed wound healing, decubitus ulcers


N/A N/A N/A N/A N/A N/A N/A


37 POSSIBLE NUTRITION-RELATED CAUSES ADDITIONAL INFORMATION


Possible non–nutrition-related causes: Pulmonary and cardiovascular disease • Irritable bowel disease • Liver disease • AIDS • Cystic fibrosis • Celiac disease


Possible non–nutrition-related causes: Nail trauma or injury


Possible non–nutrition-related cause: Chronic kidney disease


Additional information: Apparent leukonychia


Possible non–nutrition-related causes: Cirrhosis • Congestive heart failure • Diabetes mellitus • Old age


Additional information: Apparent leukonychia


Additional information: Often a normal variant in African Americans


Additional information: Most common in people of color • Criteria if pigmented nail lesion a melanoma— age/race, width, change, digit, extension of pigmentation, family history


Possible non–nutrition-related causes: Psoriasis • Alopecia areata • Reiter syndrome


Deficiency: Zinc • Vitamin C • Vitamin A Other: Malnutrition^ • Inadequate hydration


Possible non–nutrition-related causes: Poor skin care • Diabetes mellitus • Steroid use


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