Current Practices Using Pediatric Malnutrition Indicators: A Survey of Dietitians Working in Pediatrics

Abstract

Background: In 2014, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition recommended indicators to identify malnutrition in children aged 1 month to 18 years. The purpose of this study was to evaluate current practices and the effectiveness of the consensus statement-recommended pediatric malnutrition indicators. Methods: A cross-sectional electronic survey link was posted in the Pediatric Nutrition Practice Group (subscribers = 3160) and Clinical Nutrition Management Practice Group's Pediatric Subunit (subscribers = 177) community discussion boards. Additionally, flyers with the survey link were distributed to registered dietitian nutritionists (RDNs) currently working in pediatrics at the 2018 Food & Nutrition Conference & Expo. Frequencies described participant characteristics, awareness of indicators, and use of indicators. Researchers used the Fisher exact test to determine associations between categorical variables. Results: Two hundred eighty-one surveys were included in data analysis. A majority of RDNs (88.6%) reported they knew the indicators existed and considered themselves knowledgeable about the indicators. Weight loss was the most frequently used indicator, with 224 RDNs (80%) reporting use as often or always. Mid-upper arm circumference (MUAC) was the least used indicator with only 68 RDNs (25%) using it often or always. Most RDNs (71.5%) reported that their facility used International Classification of Disease, Tenth Revision codes to document malnutrition. Conclusion: RDNs working with pediatric populations consistently use the recommended malnutrition indicators; however, further education is needed on the appropriate use of MUAC and length/height per age as malnutrition indicators.

Pediatric malnutrition screening and assessment tools: Analyzing the gaps

“…The pediatric MNRS systematic review also found that MUAC, which is used around the world as a malnutrition screening tool, was underutilized in the US for this purpose 7 . In a survey of dietitians working in pediatrics, a similar conclusion was revealed by the survey results, 46 which stated that infrequent use of MUAC as documented by survey respondents revealed a need for further education on interpreting MUAC. Specifically, the open‐ended question responses indicated educational opportunities for measuring and interpreting MUAC as an MNRS and diagnosis tool 46 …”

“…Specifically, the open-ended question responses indicated educational opportunities for measuring and interpreting MUAC as an MNRS and diagnosis tool. 46 In the ASPEN/Academy Pediatric consensus statement for the identification of PMN, the authors recommend that MUAC should be measured when assessing the NS of pediatric patients and that MUAC can be used as an independent anthropometric assessment tool in determining malnutrition in children 6-59 months of age when compared with the standards developed by WHO. 16 It was noted at the time that reference ranges with standard deviations were not available for older children and adolescents, although percentile guidelines for ages 1-79 years were available.…”

When Reality and Research Collide: Guidelines Are Essential for Optimal Nutrition Care in Pediatric Oncology

“…This finding was consistent with a recent practice survey evaluating the malnutrition assessment practices of pediatric dietitians, in which only 47% of respondents often or always evaluated muscle and fat losses, and <30% of respondents often or always evaluated signs of micronutrient deficiencies or functional status changes. 46 Barriers to including an NFPE reported by our respondents included lack of understanding/ training, discomfort associated with doing an examination, and lack of time. In a study conducted by Desjardins et al, 47 they found that RDNs were more likely to perform an NFPE independently if they had additional training on how to conduct an NFPE.…”

Comparison of three different nutrition screening tools for pediatric inpatients

“…Childhood malnutrition adversely affects the growth and development of children. It is associated with an increase in comorbidity rates of communicable and noncommunicable diseases, hospitalization frequency, length of stay, and healthcare costs; lower survival rates; and a decline in cognitive performance in the long term 2 . The World Health Organization (WHO) has reported that infants and children <5 years of age are at greater risk of malnutrition because of their high growth rates and brain development.…”

“…It is associated with an increase in comorbidity rates of communicable and noncommunicable diseases, hospitalization frequency, length of stay, and healthcare costs; lower survival rates; and a decline in cognitive performance in the long term. 2 The World Health Organization (WHO) has reported that infants and children <5 years of age are at greater risk of malnutrition because of their high growth rates and brain development. In addition, 49 million children <5 years of age worldwide are too short for their age (stunted), and 45 million children are too underweight for their height (wasted).…”