Clinical investigations from the RACP

Investigating the child with malnutrition

Clinical investigations from the RACP

Investigating the child with malnutrition

David Brewster

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.