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How to use: nutritional assessment in children
  1. Anthony E Wiskin1,2,
  2. Mark J Johnson2,
  3. Alison A Leaf2,
  4. Stephen A Wootton1,2,
  5. R Mark Beattie3
  1. 1Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
  2. 2NIHR Southampton Biomedical Research Centre, Hampshire, UK
  3. 3University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
  1. Correspondence to Dr Anthony E Wiskin, Southampton Centre for Biomedical Research, MP113, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, UK; a.wiskin{at}

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One-fifth of children in hospitals are undernourished. Ignorance of undernourishment results in poorer outcomes for those children: longer hospital stays, complications and readmission.1 Nutritional assessment ought, therefore, to be a key feature of any holistic care and form part of routine practice.2 It is only by identifying poor growth and shortfalls in nutrient intake that it is possible to form an appropriate management plan. The purpose of this article is to provide an overview of how clinicians might approach nutritional assessment of children as part of their regular clinical practice.

Physiological background

Growth reference standards

Measurements of height and weight in children need to be interpreted relative to a reference population. Growth charts used in the UK are a combination of the WHO growth standards (0–4 years) and the UK 1990 (4–18 years). Data for the UK 1990 growth reference charts were collated from seven different sources and include measurements taken between 1978 and 1990 on over 25 000, predominantly white, British children.3 The WHO growth standards were derived from the WHO Multicentre Growth Reference Study (MGRS), which monitored the growth of children in optimum conditions (including exclusive breast feeding for 6 months) in six different countries around the world.4 The MGRS study demonstrated that across the globe children grow in a similar pattern provided optimum conditions are met and is the first data produced as a reference of how children should grow.

Recommended nutrient intakes

The UK Department of Health has published recommendations for children and adults for the intakes of most major macronutrients and micronutrients, in the form of Dietary Reference Values (DRVs).5 DRVs include:

  • Estimated average requirement (EAR): The average requirement value of a specific nutrient for a specific population, based on given criteria (usually related to amounts required to prevent deficiency of the nutrient);

  • Reference nutrient intake: The amount a nutrient that will prevent …

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  • Competing interests RMB has received sponsorship from Mead Johnson, Nestle and Nutricia in lieu of medical advisory work, invited lectures and conference attendance.

  • Provenance and peer review Commissioned; internally peer reviewed.