Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Indications for nutritional assessment in childhood

Sarah M Phillips, MS, RD, LD
Craig Jensen, MD
Section Editor
Kathleen J Motil, MD, PhD
Deputy Editor
Alison G Hoppin, MD


The goal of nutritional assessment in childhood is to prevent nutritional disorders and the increased morbidity and mortality that accompany them. To meet this goal, pediatric clinicians must know the risk factors for obesity and protein energy malnutrition and must understand the normal and abnormal patterns of growth and the changes in body composition during childhood and adolescence. In addition, they must be able to accurately perform and interpret the results of the nutritional evaluation [1].

Nutritional assessment is the quantitative evaluation of nutritional status. A comprehensive nutritional assessment has five components:

Dietary, medical, and medication history

Physical examination

Growth, anthropometric, and body composition measurements

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Beer SS, Juarez MD, Vega MW, Canada NL. Pediatric Malnutrition: Putting the New Definition and Standards Into Practice. Nutr Clin Pract 2015; 30:609.
  2. Ogden CL, Carroll MD, Lawman HG, et al. Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988-1994 Through 2013-2014. JAMA 2016; 315:2292.
  3. Kossmann J, Nestel P, Herrera MG, et al. Undernutrition in relation to childhood infections: a prospective study in the Sudan. Eur J Clin Nutr 2000; 54:463.
  4. Shepherd RW, Chin SE, Cleghorn GJ, et al. Malnutrition in children with chronic liver disease accepted for liver transplantation: clinical profile and effect on outcome. J Paediatr Child Health 1991; 27:295.
  5. Ishikawa M, Lynch SV, Balderson GA, et al. Liver transplantation in Japanese and Australian/New Zealand children with biliary atresia: a 10-year comparative study. Eur J Surg 1999; 165:454.
  6. Hecht C, Weber M, Grote V, et al. Disease associated malnutrition correlates with length of hospital stay in children. Clin Nutr 2015; 34:53.
  7. Castañeda-Martínez PD, Alcaide-Ortega RI, Fuentes-García VE, et al. Anesthetic risk factors associated with early mortality in pediatric liver transplantation. Transplant Proc 2010; 42:2383.
  8. Barshes NR, Chang IF, Karpen SJ, et al. Impact of pretransplant growth retardation in pediatric liver transplantation. J Pediatr Gastroenterol Nutr 2006; 43:89.
  9. Must A, Jacques PF, Dallal GE, et al. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992; 327:1350.
  10. van Dam RM, Willett WC, Manson JE, Hu FB. The relationship between overweight in adolescence and premature death in women. Ann Intern Med 2006; 145:91.
  11. Must A, Phillips SM, Naumova EN. Occurrence and timing of childhood overweight and mortality: findings from the Third Harvard Growth Study. J Pediatr 2012; 160:743.
  12. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC growth charts: United States. Advance data from vital and health statistics. Number 314. National Center for Health Statistics; Centers for Disease Control and Prevention, Hyattsville, MD 2000.
  13. Kanof ME, Lake AM, Bayless TM. Decreased height velocity in children and adolescents before the diagnosis of Crohn's disease. Gastroenterology 1988; 95:1523.
  14. Wells JC, Fuller NJ, Dewit O, et al. Four-component model of body composition in children: density and hydration of fat-free mass and comparison with simpler models. Am J Clin Nutr 1999; 69:904.
  15. Butte N, Heinz C, Hopkinson J, et al. Fat mass in infants and toddlers: comparability of total body water, total body potassium, total body electrical conductivity, and dual-energy X-ray absorptiometry. J Pediatr Gastroenterol Nutr 1999; 29:184.
  16. Fjeld CR, Schoeller DA, Brown KH. Body composition of children recovering from severe protein-energy malnutrition at two rates of catch-up growth. Am J Clin Nutr 1989; 50:1266.
  17. Shepherd RW, Holt TL, Johnson LP, et al. Leucine metabolism and body cell mass in cystic fibrosis. Nutrition 1995; 11:138.
  18. Rinninella E, Ruggiero A, Maurizi P, et al. Clinical tools to assess nutritional risk and malnutrition in hospitalized children and adolescents. Eur Rev Med Pharmacol Sci 2017; 21:2690.
  19. Mehta NM, Corkins MR, Lyman B, et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr 2013; 37:460.
  20. Grummer-Strawn LM, Reinold C, Krebs NF, Centers for Disease Control and Prevention (CDC). Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States. MMWR Recomm Rep 2010; 59:1.
  21. World Health Organization. The WHO Child Growth Standards. Available at: www.who.int/childgrowth/standards/en/ (Accessed on February 27, 2008).
  22. Mei Z, Grummer-Strawn LM, Pietrobelli A, et al. Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents. Am J Clin Nutr 2002; 75:978.
  23. Becker P, Carney LN, Corkins MR, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutr Clin Pract 2015; 30:147.
  24. Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013; 128:1689.
  25. Taveras EM, Rifas-Shiman SL, Sherry B, et al. Crossing growth percentiles in infancy and risk of obesity in childhood. Arch Pediatr Adolesc Med 2011; 165:993.
  26. Joosten KF, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr 2008; 20:590.
  27. Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr 2000; 72:64.
  28. Hendricks KM, Duggan C, Gallagher L, et al. Malnutrition in hospitalized pediatric patients. Current prevalence. Arch Pediatr Adolesc Med 1995; 149:1118.
  29. Beisel WR. Interrelated changes in host metabolism during generalized infectious illness. Am J Clin Nutr 1972; 25:1254.
  30. Sala A, Rossi E, Antillon F. Nutritional status at diagnosis in children and adolescents with cancer in the Asociacion de Hemato-Oncologia Pediatrica de Centro America (AHOPCA) countries: preliminary results from Guatemala. Pediatr Blood Cancer 2008; 50:499.
  31. Sala A, Pencharz P, Barr RD. Children, cancer, and nutrition--A dynamic triangle in review. Cancer 2004; 100:677.
  32. Iniesta RR, Paciarotti I, Brougham MF, et al. Effects of pediatric cancer and its treatment on nutritional status: a systematic review. Nutr Rev 2015; 73:276.
  33. Lobato-Mendizábal E, López-Martínez B, Ruiz-Argüelles GJ. A critical review of the prognostic value of the nutritional status at diagnosis in the outcome of therapy of children with acute lymphoblastic leukemia. Rev Invest Clin 2003; 55:31.
  34. Brinksma A, Sanderman R, Roodbol PF, et al. Malnutrition is associated with worse health-related quality of life in children with cancer. Support Care Cancer 2015; 23:3043.
  35. Barr RD. Nutrition, cancer, and children. Nutrition 2002; 18:434.
  36. Ladas EJ, Sacks N, Meacham L, et al. A multidisciplinary review of nutrition considerations in the pediatric oncology population: a perspective from children's oncology group. Nutr Clin Pract 2005; 20:377.
  37. Rogers PC, Melnick SJ, Ladas EJ, et al. Children's Oncology Group (COG) Nutrition Committee. Pediatr Blood Cancer 2008; 50:447.
  38. Veringa SJ, van Dulmen-den Broeder E, Kaspers GJ, Veening MA. Blood pressure and body composition in long-term survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2012; 58:278.
  39. Garmey EG, Liu Q, Sklar CA, et al. Longitudinal changes in obesity and body mass index among adult survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. J Clin Oncol 2008; 26:4639.
  40. Ventham JC, Reilly JJ. Childhood leukaemia: a model of pre-obesity. Proc Nutr Soc 1999; 58:277.
  41. Schwarz SM, Corredor J, Fisher-Medina J, et al. Diagnosis and treatment of feeding disorders in children with developmental disabilities. Pediatrics 2001; 108:671.
  42. Stewart L, Van de Ven L, Katsarou V, et al. High prevalence of obesity in ambulatory children and adolescents with intellectual disability. J Intellect Disabil Res 2009; 53:882.
  43. Rimmer JH, Yamaki K. Obesity and intellectual disability. Ment Retard Dev Disabil Res Rev 2006; 12:22.
  44. Rimmer JH, Wang E. Obesity prevalence among a group of Chicago residents with disabilities. Arch Phys Med Rehabil 2005; 86:1461.
  45. Baer MT, Harris AB. Pediatric nutrition assessment: identifying children at risk. J Am Diet Assoc 1997; 97:S107.