School-age Child Nutrition Assessment (5–9 Years) Format

School Health, Growth & PM POSHAN

Used by dietitians, nutrition students, hospitals and health workers across India.

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What the format covers

Child Profile

  • Registration / OPD No.
  • Date of Assessment
  • Contact No.
  • Address
  • Referred By
  • Ward / Bed No.
  • Modified Kuppuswamy scale class
  • Medical diagnosis / chief complaint
  • Past medical & surgical history
  • Family history
  • Physical activity level (ICMR-NIN 2020)
  • Child's Name
  • Date of Birth
  • Age at assessment
  • Sex
  • Parent / guardian name
  • School / class

Anthropometry — WHO 2007 Growth Reference

  • Weight (kg)
  • Height (cm)
  • BMI (numeric; not adult category)
  • BMI-for-age z-score (SD)
  • WHO 2007 BMI-for-age classification
  • Height-for-age z-score (SD)
  • WHO 2007 height-for-age classification
  • Weight-for-age z-score (valid to 10 years) (SD)
  • Weight-for-age classification
  • MUAC (cm)

School & Lifestyle

  • PM POSHAN mid-day meal
  • Breakfast before school
  • School tiffin / foods packed
  • Screen time (hours/day)
  • Outdoor play (minutes/day)
  • Sleep duration (hours/night)

School-age Clinical Screening

  • Haemoglobin (g/dL)
  • WHO anaemia category (5–11 years)
  • Deworming date
  • Vitamin A supplementation given (verify indication)
  • Biweekly IFA syrup/tablets (Anaemia Mukt Bharat 5–9 years / junior programme)
  • Dental caries
  • RBSK 4Ds screening notes — defects, diseases, deficiencies, developmental delays

Dietary Assessment

  • Diet Type
  • No. of Meals/Day
  • Appetite
  • Food Allergy / Intolerance
  • Food Aversions
  • Food Preferences
  • Water Intake (litres/day)
  • Alcohol Consumption
  • Tobacco Use
  • 24-hour dietary recall — table: Time, Meal, Food / dish, Ingredients, Household measure, Approx. quantity (g/mL)
  • Food frequency — table: Frequency, Usual portion
  • Nutritional Supplements

Nutrition-Focused Physical Examination (NFPE)

  • Muscle wasting
  • Subcutaneous fat loss
  • Oedema
  • Hair
  • Eyes
  • Mouth
  • Skin
  • Nails
  • Goitre
  • Handgrip strength (optional) (kg)

Nutrition Diagnosis & Risk Stratification

  • Nutritional status (age-specific clinical assessment)
  • Overweight/obesity status
  • PES: Problem
  • PES: Etiology (Related to)
  • PES: Signs & Symptoms (Evidenced by)

Nutrition Care Plan & Recommendations

  • Energy Requirement (clinician prescribed) (kcal/day)
  • Protein Requirement (g/day)
  • Special Nutrient Focus
  • Dietary Advice / Modifications
  • Sample Meal Plan Given?
  • Next Follow-Up Date
  • Counselling Notes
  • Monitoring & Evaluation — table: Indicator, Baseline, Target, Review date, Outcome
  • Reference (guideline) — dietitian to prescribe: ICMR-NIN 2020 age-band energy / protein reference

Diet Prescription (filled by dietitian)

  • Prescribed energy (kcal/day)
  • Prescribed protein (g/day)
  • Prescribed fluid (mL/day)
  • Diet type / consistency
  • Restrictions
  • Meal plan — table: Time, Food / dish, Quantity (household measure)
  • Foods to include
  • Foods to avoid
  • Prescribed by (name, reg. no.)

Signature

  • Dietitian Name & Signature

Automatic scores in this form

  • Age at assessment
  • BMI (numeric; not adult category)
  • WHO 2007 BMI-for-age classification
  • WHO 2007 height-for-age classification
  • Weight-for-age classification
  • WHO anaemia category (5–11 years)
  • Reference (guideline) — dietitian to prescribe: ICMR-NIN 2020 age-band energy / protein reference

All calculated values are indicative — clinical judgement required.

Standards & references

  • WHO Growth Reference 2007
  • IAP 2015 growth charts
  • ICMR-NIN 2020
  • MoHFW RBSK
  • PM POSHAN
  • Anaemia Mukt Bharat
  • GLIM 2019
  • Nutrition Care Process (ADIME)

Frequently asked questions

What is included in the School-age Child Nutrition Assessment (5–9 Years) format?

The format has 10 sections: Child Profile; Anthropometry — WHO 2007 Growth Reference; School & Lifestyle; School-age Clinical Screening; Dietary Assessment; Nutrition-Focused Physical Examination (NFPE); Nutrition Diagnosis & Risk Stratification; Nutrition Care Plan & Recommendations; Diet Prescription (filled by dietitian); Signature. It also calculates 7 values automatically, such as Age at assessment, BMI (numeric; not adult category), WHO 2007 BMI-for-age classification.

Which guidelines does the School-age Child Nutrition Assessment (5–9 Years) follow?

It follows WHO Growth Reference 2007, IAP 2015 growth charts, ICMR-NIN 2020, MoHFW RBSK, PM POSHAN, Anaemia Mukt Bharat, GLIM 2019, Nutrition Care Process (ADIME). All calculated values are indicative — clinical judgement is required.

Can I download the School-age Child Nutrition Assessment (5–9 Years) as a PDF?

Yes. After a free sign-up you can fill the form online and download both blank and filled A4 PDFs, and save private case sheets for your patients.

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