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Clinical investigations from the RACP

Investigating the child with malnutrition

David Brewster

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Abstract

Growth failure is the principal manifestation of malnutrition in children. Major organic disease is uncommon. A detailed dietary history and assessment for psychosocial deprivation are important.

Key Points

  • Growth failure is the principal manifestation of malnutrition in children.
  • Normal growth variations and errors in charting must be recognised and not labelled as malnutrition.
  • Anthropometric assessment can differentiate wasting and stunting.
  • In the primary care setting, major organic disease is uncommon (<5%) and can usually be suspected on clinical assessment.
  • Routine hospital admission with an expensive laboratory work-up to exclude rare causes is considered inappropriate medical practice in the absence of other manifestations of illness.
  • A detailed dietary history and assessment for psychosocial deprivation are important.
  • Dietary improvement with home visits has been shown to increase growth in a fifth of children in a community study.

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