Diagnosing malnutrition in children: What parents should look for

During training, pediatricians learn the traditional definitions of malnutrition in children, which focus on “nutrient scarcity.” Pediatric malnutrition — or under nutrition — contributes to an estimated 45 percent of all children’s deaths around the world.^[1]  But such forms of malnutrition are rarely seen in the developed world.

However, that’s not to say that malnutrition is not a problem in the United States.  It is.

According to the Journal of the American Dietetic Association, one-third of patients arrive at the hospital malnourished. Another third that aren’t malnourished upon admission become so while in the hospital.^[2] Left untreated, these patients continue to decline nutritionally, increasing their risk of complications and readmission. ^[3][4]

But diagnosing malnutrition in children in this country is tricky due, in part, to the fact that, until recently, there hasn’t been a uniform way to make the diagnosis. Traditionally, the diagnosis of pediatric malnutrition focused solely on “anthropometric assessment” which looks at weight, length/height, and head circumference. But that doesn’t always tell the whole story. Often being malnourished is indicative of an underlying health problem.  It’s not necessarily that food is scarce, but rather the child can’t absorb the nutrients in the food.

This is especially true when the child has a chronic disease. It is not unusual to see malnutrition in children with conditions such as Crohn’s disease, congenital heart disease, or cystic fibrosis.

With all this in mind, the American Society for Parenteral and Enteral Nutrition (ASPEN) established a task force to develop a new definition of pediatric malnutrition, which was finalized and approved in 2013.^[5] This revised definition is intended to help healthcare providers, school nurses and parents better identify malnutrition in kids earlier by looking for signs that go beyond simple lack of food and growth statistics.

According to ASPEN, indications that your child might not be getting the proper nourishment include:

• Not eating enough;
• Getting full too quickly;
• Not gaining weight as they should;
• In the case of infants, only “dream feeding;” and
• A lot of vomiting.

And if you do think your child might have signs of being malnourished, don’t panic.  This is a condition that can be fixed.  Talk to your pediatrician about your concerns. Working together, you can identify the problem and give your child the best chance to achieve optimal health.  Parents recognizing the signs — and physicians intervening earlier — can save you a great deal of unnecessary anxiety.

Malnutrition Awareness Week, September 28 – October 2, is intended to do just that: raising awareness among healthcare professionals to assess and intervene earlier and educating the public to ask about their children’s nutrition status and advocate for optimal nutrition care.

Nutrition is imperative to clinical outcomes. It should not be treated as an afterthought but rather a critical component of comprehensive care. When that is the case, children grow, develop and thrive.

By Dr. Mark Corkins, MD and Traci Nagy

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Dr. Mark Corkins, MD, CNSP, SPR, FAAP is an Associate Professor of Pediatrics at Indiana University School of Medicine and James Witcomb Riley Hospital for Children and is the Co-Director of Nutrition Support at Riley Hospital for Children.

Traci Nagy is the founder of the Feeding Tube Awareness Foundation, a non-profit organization, which provides education and emotional support to parents of children who have feeding tubes.

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[1] http://www.who.int/mediacentre/factsheets/fs178/en/

[2] Braunschweig C, Gomez S, Sheean PM. Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days. J Am Diet Assoc. 2000;100:1316-1322; quiz 1323-1324.

[3] Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8:514-527.

[4] Bistrian BR, Blackburn GL, Hallowell E, Heddle R. Protein status of general surgical patients. JAMA. 1 74;230:858-860.

[5] Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Nieman Carney L, Moncza JL, Plogsted SW, Schwenk WF. Defining Pediatric Malnutrition, A Paradigm Shift Toward Etiology-Related Definitions. J Parenter Enteral Nutr July 2013; 37(4):460-481.