DEFINITION OF MALNUTRITION    CAUSES OF MALNUTRITION     BURDEN OF MALNUTRITION    IMPORTANCE OF ASSESSMENT AND EARLY IDENTIFICATION    CHALLENGES OF SCREENING    NUTRITIONAL AWARENESS AND SCREENING TOOLS    THE IMPORTANCE OF MEDICAL NUTRITION    DISCOVER SIMILAC HIGH ENERGY    PAEDIASURE RANGE

DEFINITION OF MALNUTRITION

Malnutrition refers to deficiencies, excesses, or imbalances in the intake of energy and/or nutrients.¹

Malnutrition can occur in both under and overweight patients. The term malnutrition addresses¹:

CAUSES OF MALNUTRITION

There are many clinical and socio-economic causes of malnutrition in children, including^2-3:

• Chronic illness
• Behavioural or psychological conditions
• Medication / treatment
• Food refusal and ARFID
• Food insecurity
• Neglect and abuse

BURDEN OF MALNUTRITION FOR PAEDIATRIC HEALTH OUTCOMES

Malnutrition is common in children and it can be costly:

*Children already accessing healthcare services

This can have devastating consequences for paediatric patient outcomes^7-9:

• Stunted growth
• Hindered cognitive development
• Increased risk of morbidity and mortality
• Negative behavioural changes
• Increased risk of infection
• Poor sleep patterns

IMPORTANCE OF NUTRITIONAL ASSESSMENT AND EARLY IDENTIFICATION

In 2023 more than 400,000 children are reported to be waiting to see paediatric specialist within the UK, with 18,000 waiting over 1 year for treatment.¹⁰

Identifying malnutrition early is vital to provide timely and appropriate nutritional intervention.¹¹ Nutritional assessment and screening is a quick and simple way to identify malnutrition¹² and is advocated by The World Health Organisation (WHO)¹³, Care Quality Commission (CQC)¹⁴ and NHS England.¹⁵

Studies show that identifying malnutrition early can¹⁶:

• Improve patient outcomes
• Help save costs
• Reduce length of hospital stays

CHALLENGES OF SCREENING

Despite the importance of screening for malnutrition, there are often systematic barriers, which can make screening difficult, including:¹⁷

• Challenges in dietetic support    
• Communication difficulties between HCPs
• Difficulties monitoring treatment goals
• Availability of resources to manage malnutrition
• Limited nutritional training opportunities

Pedi R-MAPP is a validated, easy-to-use digital nutritional awareness tool that supports HCPs in completing a nutrition-focussed consultation. It can be used by any healthcare professional, on any part of the patient pathway, either during remote consultations, or as part of a face-to-face appointment.

With just 8 simple steps, it can be completed in as little as 2 minutes and is easy-to-use as part of routine clinical appointments.

Secondary care: STAMP

STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics) is a validated nutrition screening tool for use in hospitalised children from 2 weeks to 16 years of age. It is quick and easy-to-use, with just 5 simple steps to follow.

It has been developed to aid the early identification and treatment of malnutrition in hospitalised children and is intended for use by all healthcare professionals as part of patients’ routine treatment. 

Mid-Upper Arm Circumference (MUAC) Tape Measure

MUAC Z-score tapes are a simple, inexpensive and easy way to measure malnutrition risk in children. It is a helpful nutritional assessment for all children as changes over time, particularly for very large or very small children, are easier to understand in order to track the progress of nutritional intervention. 

MUAC Z-score tapes are available to support screening in both primary and secondary care settings and can be obtained via your Abbott representative.. 

THE IMPORTANCE OF MEDICAL NUTRITION

The management of malnutrition in paediatrics is shown to have significant benefits, particularly for children with underlying medical conditions:

• Children with cancer – early nutritional intervention can help improve quality of life and completion of treatment¹⁸ and are typically used to prevent or restore abnormalities in growth¹⁹
• Children with neurological impairment – nutritional support may restore linear growth, normalise weight, improve wound healing and circulation, reduce frequency of hospitalisation and improve quality of life²⁰
• Children with gastrointestinal (GI) conditions – peptide-based feeds have been associated with improved GI symptoms and reduced risk of diarrhoea.²¹ Studies also show that fibre may reduce flares in Crohn’s disease patients and may impact  remission in inflammatory bowel disease patients²²

Nutritional interventions should always be tailored to the child. Oral routes should be tried initially but if oral intake is not possible due to underlying disease or treatment, enteral tube feeding should be considered.¹⁹ 

DISCOVER SIMILAC HIGH ENERGY AND PAEDIASURE RANGES

Similac High Energy

Similac High Energy is a nutritionally complete formula for infants and young children aged 0-18 months or weighing up to 8kg. It is scientifically developed to promote catch-up growth through higher levels of protein, energy, vitamins and minerals compared to standard formula for infants and young children.²³ Additionally it supports brain development and provides excellent tolerance.^24-27

• High energy – provides 1.0kcal/ml in a 200ml bottle
• For infants and young children with, or at risk of, faltering growth from birth to 8kg^*
• Nutritionally complete^‡
• Ready to use orally or as a tube feed

Paediasure range

The PaediaSure range of oral and tube nutritional supplements provide complete and balanced nutrition for children with disease-related malnutrition and faltering growth.

• PaediaSure is the No.1 HCP recommended paediatric ONS^**28
• Offers the widest choice and best tasing range^†29-31 giving you the confidence that children will take their supplements
• Contains MCTs^*** to support improved tolerance 
• The only range suitable for 8-30kg (age 1-10)³²
• Available in both ready-to-drink ONS^** and tube feeds to meet the individual needs of children at all stages of their condition

Find out more about our great tasting range of products
that can help improve patient outcomes

UK-N/A-2300230 (V2) | October 2023

ARFID: Avoidant restrictive food intake disorder

Footnotes

* Similac High Energy is suitable as sole source of nutrition for oral and enteral feeding of infants and children up to 8kg in weight (or 18 months of age). ‡ Based on UK DRVs, Department of Health, excluding electrolytes chloride, potassium and sodium. ^Claim pertains to both palm oil and palm olein oil **Oral Nutritional Supplements †Independent, head-to-head testing for PaediaSure, PaediaSure Plus, PaediaSure Fibre, PaediaSure Plus Fibre, PaediaSure Peptide vs Fortini or Frebini Energy or Peptamen Junior Powder and PaediaSure Compact. ***Medium Chain Triglycerides.

References

1. WHO, 2021: Malnutrition. Available online: https://www.who.int/news-room/fact-sheets/detail/malnutrition. Last accessed February 2023. 2. Larson-Nath C et al. Nutr Clin Pract 2019;34(3):349–358. 3. NHS, 2020: Malnutrition. Available online: https://www.nhs.uk/conditions/malnutrition/causes/#:~:text=Some%20children%20may%20become%20malnourished,in%20poverty%20or%20being%20abused. Last accessed February 2023. 4. UNICEF, 2019: The changing face of malnutrition. Available online: https://features.unicef.org/state-of-the-worlds-children-2019-nutrition/. Last accessed February 2023. 5. BAPEN, 2015: The cost of malnutrition in England and potential cost savings from nutritional interventions (short version). Available online: https://www.bapen.org.uk/pdfs/economic-report-short.pdf. Last accessed February 2023. 6. BAPEN, 2015: The cost of malnutrition in England and potential cost savings from nutritional interventions (full report). Available online: https://www.bapen.org.uk/pdfs/economic-report-full.pdf. Last accessed February 2023. 7. Tette E et al. BMC pediatrics 2015;15:189. 8. Martins V et al. Int J Environ Res Public Health 2011; 8(6):1817–1846. 9. Stanga Z et al. Clin Nutr 2007; 26(3):379-382. 10. RCPCH, 2023. Record high: Over 400,000 children waiting for treatment amidst child health crisis. Available online: https://www.rcpch.ac.uk/news-events/news/record-high-over-400000-children-waiting-treatment-amidst-child-health-crisis#:~:text=Record%20high%3A%20Over%20400%2C000%20children%20waiting%20for%20treatment%20amidst%20child%20health%20crisis,-11%20May%202023&text=Startling%20new%20data%20reveals%20that,currently%20on%20the%20waiting%20list. Last accessed August 2023. 11. Reber E et al. J Clin Med 2019;8(7):1065. 12. McCarthy H et al. Journal of Human Nutrition and Dietetics 2012;25(4):311–318. 13. WHO, 2017: Assessing and managing children at primary health-care facilities to prevent overweight and obesity in the context of the double burden of malnutrition. Available online:https://apps.who.int/iris/bitstream/handle/10665/259133/9789241550123-eng.pdf. Last accessed February 2023. 14. CQC, 2022: Regulation 14: Meeting nutritional and hydration needs. Available online: https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-14-meeting-nutritional-hydration-needs. Last accessed February 2023. 15. NHS England, 2015: Nutrition and Hydration. Available online: https://www.england.nhs.uk/commissioning/nut-hyd/. Last accessed February 2023. 16. Agostoni C et al. Journal of Pediatric Gastroenterology and Nutrition 2005; 41(1):8–11. 17. Browne SI et al. Clin Nutr ESPEN 2021;44:415–423. 18.  WHO, 2020. WHO report on cancer: setting priorities, investing wisely and providing care for all. Available online: https://www.who.int/publications/i/item/9789240001299 Accessed July 2022 19. Bauer J, Jurgens H, Fruhwald M. Adv. Nutr 2011;2:67-77  2011. 20. Penagini F, et al. Nutrients 2015;7:9400-9415 21. Selimoglu MA, et al. Front. Pediatr. 2021;9:610275 22. Balestrieri P, et al. Nutrients 2020;12(2):372. 23. Clarke S. E. et al. J Hum Nutr Diet. 2007;20(4):329-39. 24. Auestad N et al. Pediatrics. 2001;108(2):372-81. 25. Auestad N et al. Pediatrics. 2003;112(3):177-83. 26. Auestad N et al. Pediatric Research. 1997;41(1):1-10. 27. Williams T et al. JPNG. 2014;59(5):653-658. 28. Based on June 2022 community prescribing data 29. Data on file. Abbott Laboratories Ltd., 2007 (PaediaSure Plus & PaediaSure Plus Fibre taste testing). 30. Abbott Laboratories Ltd., 2017 (Sensory research and evaluation: PaediaSure Plus vs. PaediaSure Compact). 31. Data on file. Abbott Laboratories Ltd., 2013 (PaediaSure & PaediaSure Peptide vs. Peptamen Junior Powder). 32. MIMS, July 2023