How to use: nutritional assessment in children

One-fifth of children in hospitals are undernourished. Ignorance of undernourishment results in poorer outcomes for those children: longer hospital stays, complications and readmission.1 Nutritional assessment ought, therefore, to be a key feature of any holistic care and form part of routine practice.2 It is only by identifying poor growth and shortfalls in nutrient intake that it is possible to form an appropriate management plan. The purpose of this article is to provide an overview of how clinicians might approach nutritional assessment of children as part of their regular clinical practice. ### Growth reference standards Measurements of height and weight in children need to be interpreted relative to a reference population. Growth charts used in the UK are a combination of the WHO growth standards (0–4 years) and the UK 1990 (4–18 years). Data for the UK 1990 growth reference charts were collated from seven different sources and include measurements taken between 1978 and 1990 on over 25 000, predominantly white, British children.3 The WHO growth standards were derived from the WHO Multicentre Growth Reference Study (MGRS), which monitored the growth of children in optimum conditions (including exclusive breast feeding for 6 months) in six different countries around the world.4 The MGRS study demonstrated that across the globe children grow in a similar pattern provided optimum conditions are met and is the first data produced as a reference of how children should grow. ### Recommended nutrient intakes The UK Department of Health has published recommendations for children and adults for the intakes of most major macronutrients and micronutrients, in the form of Dietary Reference Values (DRVs).5 DRVs include: