The most appropriate method of evaluating whether the diet of a child with cystic fibrosis is meeting his caloric needs is:

The most appropriate and definitive method for evaluating the adequacy of a nutritional plan for a child with cystic fibrosis (CF) is by monitoring weight and growth patterns. Children with CF have high caloric needs due to increased metabolic demands and malabsorption. Consistent weight gain, plotted on a standard growth chart, is the primary objective indicator that caloric intake is sufficient to meet these needs and support appropriate growth. While dietary records are useful, the ultimate measure of success is the child's physical response to the diet.

B. This assesses dietary intake, not whether the intake is meeting the child's high metabolic and growth requirements, especially considering malabsorption.

C. This measures caloric input but fails to account for the variable absorption of nutrients, which is a hallmark of pancreatic insufficiency in cystic fibrosis.

D. Monitoring enzyme intake is crucial for managing digestion, but it is a therapeutic intervention, not a direct evaluation of nutritional status or caloric adequacy.

1. Hockenberry, M. J., & Wilson, D. (2019). Wong's nursing care of infants and children (11th ed.). Elsevier. In Chapter 20, The Child with a Respiratory Dysfunction, the text emphasizes that a primary nursing goal for children with cystic fibrosis is to ensure adequate nutrition for growth, which is evaluated by routinely monitoring and plotting weight and height on growth charts (p. 629).

2. Turck, D., Braegger, C. P., Colombo, C., et al. (2016). ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clinical Nutrition, 35(3), 557-577. Section 3.1, "Nutritional Assessment," states, "Regular anthropometric assessment is the cornerstone of nutritional monitoring in CF," highlighting the importance of measuring weight, height, and body mass index. https://doi.org/10.1016/j.clnu.2016.03.004

3. Borowitz, D., Robinson, K. A., Rosenfeld, M., et al. (2002). Cystic Fibrosis Foundation evidence-based guidelines for management of infants with cystic fibrosis. The Journal of Pediatrics, 141(5), 612-627. The guidelines state that nutritional management success is assessed by "monitoring growth parameters" and maintaining weight-for-length above the 50th percentile (p. 620). https://doi.org/10.1067/mpd.2002.129493