Basic Clinical Assessment of Pediatric Malnutrition

Abstract

Screening and assessment for nutritional risk should be a routine part of clinical evaluation. Goals of nutritional assessment are to determine the risk or presence of malnutrition and to provide guidelines for short- and long-term therapy. Nutritional status is assessed through a simple, mainly clinical approach based on medical history, physical examination, anthropometric measurements, dietary intake, body composition and biological parameters. Nutritional status assessment should start by history and physical examination combined with dietary record. When a child is assumed to be at risk of malnutrition, evaluation for inadequate intake, reduced absorption, excessive losses, impaired utilization or increased requirements is needed. Growth is the best indicator of nutritional status. Analysis of growth (weight gain and growth velocity) using growth curves remains the simplest tool for assessing changes in nutritional status. Other anthropometric indices used for the assessment of nutritional status are body mass index, skinfold thickness and mid-arm circumference (MAC). Several classifications are used to define malnutrition, but none has been properly validated for diagnosing malnutrition in children. To date, routine nutritional screening is rarely carried out in pediatric patients due to the lack of a simple and valid nutritional screening tool. An easy-to-use screening tool that has been validated in a variety of pediatric conditions is yet to be developed.