Malnutrition (Undernutrition) Clinical Pathway — Inpatient

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Screen for Malnutrition on Admission
(MD, NP, PA, RD, RN)

Risk Factors for Malnutrition
Contact RD for children where accurate anthropometrics (including height) cannot be obtained
< 1 mo corrected Infants born < 37 wks gestational age or < 1 mo Infants born > 37 wks gestational age	Inadequate Intake Inadequate Weight Gain (Weight Gain Velocity) Decline in Weight-for-age Z-score Consider referring to Infant Malnutrition (FTT) Clinical Pathway
1 mo (Corrected Age) to 24 mos (Corrected Age) WHO Growth Charts	Weight for Length Z-score is -1 or Worse Inadequate Weight Gain (Weight Gain Velocity) Weight loss > 5% Consider referring to Infant Malnutrition (FTT) Clinical Pathway
2 yrs to ≤ 19 yrs CDC Growth Charts	BMI Z-score is -1 or Worse Weight < 5th percentile on CDC growth chart Weight loss > 5%
≥ 19 yrs CDC Growth Charts	BMI < 18.5 Weight loss ≥ 5%

No Concern for Malnutrition
No Risk Factors Present

Concern for Malnutrition
≥ 1 Risk Factor

Document normal nutritional status
and
Monitor Anthropometrics

Inpatient < 24 Hours
Refer to PCP and/or
Outpatient RD Patient Family Information

Inpatient ≥ 24 Hours
≥ 1 Risk Factor

Consult RD
FLOC and RD to document degree of malnutrition diagnosis (see Abbreviated Age-based Malnutrition Criteria Table)
Consider Additional Interventions

Posted: January 2016
Revised: March 2023
Authors: E. Bingham, RD; L. Carney, RD; E. Sullivan, RD; J. Bailer, RD; S. Weston, RD; A. Dean, RD; S. Boyden, RD;
S. Seiple, RD; L. Lo, MD; W. Chua, MD; M. Mascarenhas, MD; R. Herdes, MD

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

Inpatient Clinical Pathway for the Identification and Diagnosis of Pediatric Malnutrition

Evidence

Related Links

Inpatient Clinical Pathway for the Identification
and Diagnosis of Pediatric Malnutrition