Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition

The Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), utilizing an evidence‐informed, consensus‐derived process, recommend that a standardized set of diagnostic indicators be used to identify and document pediatric malnutrition (undernutrition) in routine clinical practice. The recommended indicators include z scores for weight‐for‐height/length, body mass index‐for‐age, or length/height‐for‐age or mid–upper arm circumference when a single data point is available. 

When 2 or more data points are available, indicators may also include weight gain velocity (<2 years of age), weight loss (2–20 years of age), deceleration in weight for length/height z score, and inadequate nutrient intake. The purpose of this consensus statement is to identify a basic set of indicators that can be used to diagnose and document undernutrition in the pediatric population ages 1 month to 18 years. The indicators are intended for use in multiple settings (eg, acute, ambulatory care/outpatient, residential care). Several screening tools have been developed for use in hospitalized children. However, identifying criteria for use in screening for nutritional risk is not the purpose of this paper. 

Clinicians should use as many data points as available to identify and document the presence of malnutrition. The universal use of a single set of diagnostic parameters will expedite the recognition of pediatric undernutrition, lead to the development of more accurate estimates of its prevalence and incidence, direct interventions, and promote improved outcomes. A standardized diagnostic approach will also inform the prediction of the human and financial responsibilities and costs associated with the prevention and treatment of undernutrition in this vulnerable population and help to further ensure the provision of high‐quality, cost‐effective nutritional care.

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WHO child growth standards and the identification of severe acute malnutrition in infants and children

The statement presents the recommended cut-offs, summarizes the rationale for their adoption and advocates for their harmonized application in the identification of 6 to 60 month old infants and children for the management of severe acute malnutrition. It reviews the implications on patient load, on discharge criteria and on programme planning and monitoring. It also recommends the increase of the MUAC cut-off for defining severe acute malnutrition in children 6 months to 5 years of age from 110 mm to 115 mm.

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