Assessing and diagnosing malnutrition is becoming standard of care. Especially in pediatric patients.
But what do you do when using the indicators isn’t clear cut?
Here’s a question we often get asked in our flagship course Infant Nutrition Essentials:
In infants where the length z-score is always trending under -3.00 along their own curve due to short stature, potentially in the context of a genetic condition, do we still diagnose as severe malnutrition even if their intake and weight gain are adequate?
You’d be surprised how often we get similar questions to this one. After a few conversations between Nutrition Masterclass and the team who developed the pediatric malnutrition consensus guidelines, here is our recommended approach:
Step #1: Review the patient’s medical history
- Is there a medical condition that is known to affect linear growth?
- Is there a specialty growth chart for this condition?
*Not sure? A quick google search will usually pop up a growth chart if one exists, and/or you can look up the condition on https://rarediseases.info.nih.
Step #2: Complete a thorough assessment of the infant’s growth
- If there are no medical condition specific growth charts, plot on the gold standard WHO growth chart and obtain z-scores for length and weight-for-length
- Review against the pediatric malnutrition indicators (see reference table below) to determine if there is presence of malnutrition and determine the degree of malnutrition
- If there is a medical condition specialty growth chart, use this chart in conjunction with the WHO growth chart to plot the growth
*Our go-to site to help us obtain z-scores for the WHO infant growth charts is Peditools.org.
Step #3: Severe malnutrition or genetic potential?
- When a patient’s linear genetic potential is known to be abnormal due to a medical condition, you cannot use length or height-for-age as a criterion to diagnose malnutrition
- In your chart note, comment that the linear growth is within normal limits, suboptimal or more than optimal comparative to xyz growth chart
Still uncomfortable with pediatric malnutrition indicators? Not sure where to start?
As soon as you suspect issues with growth or intake, you should be reviewing the pediatric malnutrition indicators developed in 2015 by the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition to ensure there is no presence of malnutrition.
To get started, refer to our blogs:
- Pediatric Malnutrition: Dietitians Make a Difference
- Online Tools for Growth and Malnutrition Assessment
For your reference, here are the pediatric malnutrition indicators:
What are we up to right now at Nutrition Masterclass:
We have a new free webinar: Back to Basics: Best Practices in Infant Feeding!
Join us for our new free webinar where we’ll take you back to the basics of infant feeding. Perfect for dietitians new to the world of infant nutrition. The live event happens on September 26th @ 1:30pm EDT and will be recorded!
You can register for our free webinar here:
|Click Here to Register for Our Free Webinar:|
Back to Basics: Best Practices in Infant Feeding
Our flagship course Infant Nutrition Essentials is open for enrollment!
INE is our comprehensive course for dietitians who want to improve their confidence and skills in infant nutrition. This 32 CPEUs course includes 8 pre-recorded modules, twice monthly Q&As, case studies to apply your knowledge and handy cheat sheets! The next round start November 1, 2023, so now’s the time to secure your spot!
You can register for INE here:
|Click Here to Register for Infant Nutrition Essentials|
Charlene and Julie
P.S. If you’d love to know more about infant nutrition, check out our flagship course Infant Nutrition Essentials here.