Infant Malnutrition Clinical Pathway — Outpatient Specialty Care and Primary Care

Assess Growth and Severity of Malnutrition

Ensuring Use of the Appropriate Growth Chart

There are many different growth charts available in Epic. For most infants, the appropriate growth chart will be the default in Epic. Clinician should be aware of the appropriate chart for the infant being measured. Plotting on the wrong chart can result in a misclassification of growth percentiles.

Growth Chart
Z-scores are used to assess malnutrition category. Refer to Growth Chart in Epic and ensure that appropriate chart is used, as detailed in table below. Peditools can be used to plot growth parameters for all infants and obtain accurate Z-scores.
Age		Plot Growth in Epic
Term Infants (born at 37 weeks or greater)	37 weeks - 24 months	WHO	If growth parameters are available, plot these on the Olsen growth chart to assess birth size (SGA, AGA, LGA).

Weight Gain Velocity
This table contains median weight gain goals to maintain growth percentiles. Infant's goal may need to be adjusted by Nutrition.
Age (corrected)	Median gm/day		Severe malnutrition < 25% median		Moderate malnutrition < 50% median		Mild malnutrition < 75% median		Infants should regain birth weight by the first 2 weeks of life and not lose more than 10% of birth weight. Weight loss should cease by day 7 of life.
	Females	Males	Females	Males	Females	Males	Females	Males
2 - 4 wks	29	34	7	9	15	17	22	26
4 wks - 2 mo	34	40	8	10	17	20	25	30
2 - 3 mo	24	27	6	7	12	14	18	20
3 - 4 mo	20	21	5	5	10	10	15	15
4 - 5 mo	16	17	4	4	8	9	12	13
5 - 6 mo	13	14	3	4	7	7	10	11
6 - 8 mo	11	11	3	3	6	6	8	8
8 - 10 mo	9	9	2	2	4	5	7	7
10 - 12 mo	8	8	2	2	4	4	6	6

Table adapted from the WHO Child Growth Standards July 2010 (25th-75th%) and Fomon SJ, Haschke F, et al.: Body composition of reference children from birth to age 10 years. Am J Clin Nutr 1982;35:1169.

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