Getting Acquainted with Pediatric Malnutrition

By Sara Glanz, MS, RD, LD, CNSC

Caring for patients who are malnourished has become an expectation for healthcare organizations. Proper care first depends on proper identification. At Dietitians On Demand, we have shone a bright light on malnutrition in adults, but malnutrition can affect pediatric patients as well.

The criteria to identify malnutrition in children are much different than those for adults. Here’s what you need to know when it comes to pediatric malnutrition.

What’s in a name?

For pediatric patients, the term ‘malnutrition’ can actually refer to a state of over- or undernutrition. That is, children who are obese may also be considered malnourished. Thus, you may see the term ‘undernutrition’ used, rather than ‘malnutrition’ in pediatric populations.

For the purposes of this article, ‘malnutrition’ will be used to refer to a state of undernutrition.

There’s a clear difference between acute and chronic malnutrition

According to the 2015 Consensus Statement between the Academy of Nutrition and Dietetics and ASPEN regarding pediatric malnutrition, acute and chronic malnutrition generally manifest quite differently. Acute malnutrition can be observed with weight loss or inadequate weight gain, whereas chronic malnutrition often results in height stunting.

Six specific indicators for pediatric malnutrition exist:

  • Food/Nutrient intake — the most basic and intuitive predictor of malnutrition.
  • Assessment of energy and protein needs — essential for determining adequacy of nutritional intake.
  • Growth parameters — includes length- or height-for-age, weight-for-age, BMI-for-age, and head circumference-for-age. Measurements are compared with WHO or CDC standardized growth charts.
  • Weight gain velocity — an early identifier of malnutrition and indicates slower than average weight gain compared with other children of the same age.
  • Mid-upper arm circumference — useful for patients whose weight is affected by edema and can be used as an independent predictor of malnutrition in children aged 6-59 months.
  • Handgrip strength — indicates a decline in muscle function, which often occurs before muscle wasting.

Get familiar with the z

Z scores indicate how many standard deviations a measurement is from the mean. In other words, if comparing a malnourished child’s weight-for-age to the CDC comparative data, a z score will tell you how atypical this child’s weight-for-age is compared to the average weight for children of his/her same age. Many of the delineations used to qualify malnutrition as mild, moderate, or severe rely on z scores.

Just as in adult populations, we are still learning more about pediatric malnutrition. You can begin by reading the Academy of Nutrition and Dietetics’ and ASPEN’s Consensus Statement on pediatric malnutrition by clicking here. In this article, you will also find the exact criteria and data points that can be used to diagnosis mild, moderate, and severe malnutrition in pediatric populations. Educate yourself, and let’s not let pediatric malnutrition go unnoticed.

Other Malnutrition Resources

Simple tips to improve your malnutrition care plans

NFPE resources for registered dietitians

Getting physical: A recap of NFPE training


Sara Glanz, MS, RD, LD, CNSC, Malnutrition Awareness

Sara Glanz, MS, RD, LD, CNSC is a travel dietitian for Dietitians On Demand. She is passionate about empowering dietitians to be more involved with the interdisciplinary healthcare team. Her favorite adventures while on assignment include: The 17-Mile Drive in Monterey, CA; Lake Placid, NY; Montreal, Canada; and of course, the Jelly Belly® Jelly Bean and Ben & Jerry’s® ice cream factories located in Fairfield, CA and Burlington, VT, respectively.


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