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Disease related Malnutrition

in Children

Child in hospital

A global problem with serious consequences for the little ones!

Malnutrition and underweight is still a significant problem in developed countries, particularly in children with underlying disease-related
malnutrition, and is an important health care issue.
Worldwide, malnutrition is an underlying cause of 53% of all deaths in children younger than 5 years.1
Malnutrition adversely impacts growth and development in children and leads to higher morbidity rates.

 

    1 in 5 children admitted to hospitals has acute* or chronic** malnutrition.

    Malnutrition is common in children in hospitals and prevalent in a wide variety of diseases.2

    Children with an underlying disease have a significantly higher prevalence of malnutrition compared to children without an underlying disease:3

    • 17% Infectious
    • 14% Surgical
    • 28% Gastrointestinal
    • 30% Respiratory
    • 25% Cardiac
    • 13% Cancer
    • 31% Neurological
    • 15% Others

    * Acute malnutrition: Wasting or thinness, acute inadequate nutrition leading to rapid weight loss or failure to gain weight normally
    ** Chronic malnutrition: Stunting or shortness, inadequate nutrition over long period of time leading to failure of linear growth

    Child with backpack

    Weight loss often occurs in children during a hospital stay
    even when well-nourished on admission4

    65% of children lost weight during their hospital stay

    45% of these children experienced a weight loss of more than 2% relative to weight at admission

    Malnutrition in children has far-reaching consequences!

    • Nutritional imbalances that are sustained for any appreciable length of time adversely affect growth in terms of height5
    • Adverse effects of malnutrition on learning, behaviour and cognition in children have been described6
    • Malnourished children performed poorly in tests of cognitive flexibility, attention, working memory, visual perception, verbal comprehension and memory7
    • Early growth faltering was associated with a significantly lower total intelligence quotient (IQ)8
    Child in hospital

    Malnutrition in children is associated with …

    • … Impaired growth and development5-10
    • … Increased morbidity11-13
    • … Increased length of hospital stay and higher health care costs3,12,14,15
    • … Increased mortality11,16,17

    Early diagnosis of malnutrition is key. 
    For effective management all children need to be screened for risk of malnutrition.

    Screening parameters

    • BMI-for-age
    • Length/height-for-age
    • Weight-for-age
    • Nutritional intake
    • Weight loss or no weight gain
    • Presence and severity of disease

    Growth charts (percentiles) as well as multi-component, child-specific screening tools for identifying children at risk of malnutrition are
    available.

    Nutritional management as easy as ABC, designed to help you and your young patients.

    A = Screening

    • Detection of malnutrition
    • Risk assessment of the causes of malnutrition

    B = Nutrition therapy

    • Define individual nutritional requirements, route(s) of nutrition and adequate nutrition support
    • Implement nutrition therapy

    C = Monitoring

    • Documentation and control of the effectiveness of nutrition therapy and the development of the child
    • Adaptation of nutrition therapy if necessary

     

    Our good nutrition practice (gnp) programme for Paediatrics

    Paediatrics Percentiles

    For documentation purposes and to control the effectiveness of the nutrition therapy and the development of the child, you can download the percentiles here.

    Filename
    gnp Percentiles Paediatrics.pdf
    Size
    11 MB
    Format
    pdf

    Paediatric patients represent a particularly vulnerable population that has specific nutritional requirements!18

    Child painting

    Higher protein needs of paediatric patients for catch up growth and/or disease specific higher demands due to

    • Infection
    • Wound healing
    • Maintenance of weight
    • Impaired GI function
    • Diarrhoeal losses

    Significantly increased requirements of LCPUFA (DHA & EPA)

    Many chronic and acute diseases involve excessive inflammation and/or immunosuppression.19 Therefore, the requirements in sick children may be significantly increased compared to healthy children.

     

    Concept_Folder_Frebini.pdf

    In our folder "Enteral Nutrition in Paediatrics" you'll find the scientific background for our Frebini products

    Filename
    Concept_Folder_Frebini.pdf
    Size
    1010 KB
    Format
    pdf

    Our dedicated enteral nutrition for children

    Frebini Sip Feeds

    • 4 delicious flavours – tested by children: Vanilla, Chocolate, Strawberry, Banana
    • In child-friendly EasyBottle, very well accepted by children
    frebini_drinks_2
    Frebini_kids.jpg

    Frebini Tube Feeds

    • Range of normo- and high caloric tube feeds with and without fibre 
    • With fibre to maintain gut physiology20
    • Fibre free for patients who cannot tolerate fibre
    • For effective nutrition according to the specific needs of children
    frebini_tube_2

    References:

    1. Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. Lancet 2005; 365(9465):1147-1152.
    2. ONS to tackle malnutrition. A summary of evidence base. Medical Nutrition International Industry (MNI), 2012.
    3. Joosten KF, Zwart H, Hop WC, Hulst JM. National malnutrition screening days in hospitalised children in the Netherlands. Arch Dis Child 2010; 95(2):141-145.
    4. Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, Brusset MC, Mosser F, Berrier F et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr 2000; 72(1):64-70.
    5. Kar BR, Rao SL, Chandramouli BA. Cognitive development in children with chronic protein energy malnutrition. Behav Brain Funct 2008; 4:31.
    6. Corbett SS, Drewett RF. To what extent is failure to thrive in infancy associated with poorer cognitive development? A review and metaanalysis. J Child Psychol Psychiatr 2004; 45(3):641-654.
    7. Black MM, Dubowitz H, Krishnakumar A, Starr RH, Jr. Early intervention and recovery among children with failure to thrive: follow-up at age 8. Pediatrics 2007; 120(1):59-69.
    8. roleau V, Babakissa C. Prevalence, impact and management of malnutrition in pediatrics unit. WCPGHAN 3 - World Congress of Pediatric Gastroenterology and Hepatology and Nutrition 2008: 1009. Ref Type: Abstract
    9. Emond AM, Blair PS, Emmett PM, Drewett RF. Weight faltering in infancy and IQ levels at 8 years in the Avon Longitudinal Study of Parents and Children. Pediatrics 2007; 120(4):e1051-e1058.
    10. Pernicka E, Wilson L, Bauer P, Schindler K, Hiesmayer M. Malnutrition assessed by BMI and weight loss causes increased length of hospital stay. Results of the NutritionDay study, Clin Nutr Suppl 2010; 5(2):168.
    11. de Souza MF, Leite HP, Koch Nogueira PC. Malnutrition as an independent predictor of clinical outcome in critically ill children. Nutrition 2012; 28(3):267-270.
    12. Hulst JM, Zwart H, Hop WC, Joosten KF. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr 2010; 29(1):106-111.
    13. Fernandez M, Ferraro AA, Antheo de Azevedo R, Neto UF. Evaluation and follow up of the nutritional status of children hospitalized in a general paediatric unit on the outskirts of the city of Sao Paulo. WCPGHAN 3 - World Congress of Pediatric Gastroenterology and Hepatology and Nutrition 2008: 850. Ref Type: Abstract.
    14. Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: an evidence based approach to treatment. Wallingford: CABI Publishing; 2003.
    15. Agostoni C, Axelson I, Colomb V, Goulet O, Koletzko B, Michaelsen KF et al. The need for nutrition support teams in pediatric units: a commentary by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr 2005;41(1):8-11.
    16. Sala A, Rossi E, Antillon F, Molina AL, de Maseli T, Bonilla M et al. Nutritional status at diagnosis is related to clinical outcomes in children and adolescents with cancer: a perspective from Central America. Eur J Cancer 2012; 48(2):243-252.
    17. Secker DJ, Jeejeebhoy KN. Subjective Global Nutritional Assessment for children. Am J Clin Nutr 2007; 85(4):1083-1089.
    18. ESPGHAN Committee on Nutrition: JPGN 2010; 51 : 110-22.
    19. Calder PC: Clin Nutr 2010; 29: 5-12.
    20. Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Schneider S, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: terminology, defi nitions and general topics. Clin Nutr 2006;25:180-6. 2

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