For early recognition and treatment of malnutrition in children, a two-track policy has been chosen:
- Diagnose the nutritional status of all children upon admission by filling in the growth curve.
- Recognition of children at risk of developing malnutrition with the STRONGkids.
Measurement of length and weight is the first step in determining the power state. This data can be expanded in a growth curve on paper, or digitally in the Growth Analyzer. This progamma contains different growth curves including weight by age, length by age, and weight by weight. Dutch clinical practice uses growth curves that indicate the SD score. The most commonly used drop-off point for malnutrition is the <-2 SD. Advantage of using the Growth Analyzer is that the program calculates the default deviation score, which is immediately visible if there is a growth decline or a decline in growth.
Children at high risk of malnutrition during the shooting can be recognized early by means of risk score instruments. In the Netherlands, a simple screening tool has been developed (STRONGkids = Screening Tool Risk On Nutritional Status and Growth) consisting of four questions, which are taken upon recording. Both the doctor, the nurse and dietitian can reduce the STRONGkids. Based on the score on the STRONGkids, the risk of malnutrition is determined and advice is given on follow-up interventions. In children included, the advice is to repeat the risk screening weekly. The tool can be found by clicking on the button on the right side of this page.
Acute or chronic malnutrition
A distinction is made between acute and chronic malnutrition. In case of acute malnutrition, weight decreases, but longevity has not yet been left. In acute malnutrition, weight loss is usually seen due to altered metabolism and reduced food intake in acute disease. In case of reduced food intake, reduced appetite and vomiting may be considered. The term “wasting” is used in the literature for slimming and / or acute malnutrition. Growth curve weight by age is used as a measure of acute malnutrition in children from 28 days to one year. The weight-growth growth curve is used to determine the nutritional status of children from the age of one year. A deflective growth curve can also be used. When the growth curve deflects in a short period of time, the child does not grow well in length and / or weight. Acute malnutrition is reported when the deflective growth curve> 1 SD decreases in three months.
Chronic malnutrition coincides with a childhood prolonged retardation and occurs in chronic illness. In addition to the disease itself, treatment can also affect nutritional status and growth. For example, medication may have nausea as a side effect or adversely affect growth, such as corticosteroids in asthma patients. The backlog in long growth is described by the term “stunting”, The growth curve with length to age and a SD of -2 is a measure of chronic malnutrition. It also looks at a trend of growth curve deflection for age. If the child <4 years is malnourished if the SD score decreases 0.5-1.0 SD in year and in children> 4 years 0.25 SD in 1 year.