Malnutrition in a children's hospital

Malnutrition may retard growth, increase the risk of infection and lengthen the duration of hospital admission, particularly in children with chronic disease. Several surveys have shown a significant but unrecognized high prevalence of undernutrition in adults admitted to hospital. However, there have been few studies of children in hospital. We aimed to measure the body weight, height and mid upper arm circumference (MUAC) of a sample of children seen at the Royal Hospital for Sick Children, Glasgow, UK. We studied 226 children (of which 93% were Caucasian) aged 7 months to 16 years (140 male, 86 female) admitted to the medical or surgical wards or out-patient clinics during a period of 9 weeks in the winter of 1994-5. Body weight was measured using an electronic balance, height with a stadiometer, and MUAC using a tape. We compared our results with published standards. Sixteen percent of children were underweight-for-age (< 5th centile), 15% were stunted (< 5th centile height-for-age) and 8% were wasted (< 80% weight-for-height). Sixteen percent were moderately undernourished or at risk of becoming so (between -1 SD and -2 SD for both weight-for-age and height-for-age) and 19% had a weight-for-height between 80% and 90% of standards. Only one-third of these malnourished children were previously recognized as such. Children with diseases of the digestive system (inflammatory bowel disease, cystic fibrosis, coeliac disease) were most at risk of undernutrition. When children with these diseases were omitted from the analyses, 13% of the remaining children were < 5th centile weight-for-age and 12% were < 5th centile height-for-age. Our findings are comparable with surveys of patients in children's hospitals elsewhere. A significant proportion of children are malnourished and this study, in common with others, indicates that undernutrition in children in hospital remains largely unrecognized by the medical and nursing staff caring for them. Body weight and height should be measured, plotted on appropriate growth standard charts and the data used to ensure that appropriate action is taken to correct undernutrition.