Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals

Abstract

Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or “a work in progress”, according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.

Editorial: Disease-associated malnutrition in paediatric patients must be diagnosed and treated

“…Today, this right is not respected in many healthcare facilities. The adoption and implementation of an effective clinical care pathway for dealing with malnutrition among paediatric patients is needed [5]. As a minimum requirement, all sick children should have weight and length measurements taken and properly interpreted, along with taking a history on feeding and on weight changes.…”

“…Of particular concern is that all too often malnutrition in sick children is not recognized, and appropriate diagnostic and therapeutic measures are not initiated in many affected children. For example, a recent survey among paediatric tertiary care hospitals in Canada found that implementation of standardized protocols for the clinical assessment and management of disease-associated malnutrition was uncommon, and routine assessment upon admission was not widely adopted [5].…”