Objectives
                            Define and interpret the etiology, severity, and 
                             mechanism of pediatric malnutrition
                            Identify AND/ASPEN pediatric malnutrition indicators 
                             and apply them to clinical practice
                            Describe best practice and considerations in the 
                             nutrition treatment plan for pediatric patients with 
                             malnutrition
                    Importance of Identifying 
                    Malnutrition
           Malnutrition Can Lead To…
             Increase               Increase   Increase   Increase    Increase
                d         Poor      d Days        d         d Re-        d 
             Infection   Wound        on       Hospital    Admissi    Mortalit
               Risk      Healing    Ventilat   LOS/ICU     on Rate       y
                                       or        LOS
              Improve nutrition status earlier in order to improve 
              outcomes
                  The sooner it is identified, the sooner nutrition 
                  intervention can occur
              If patient not identified as malnourished on admission but 
              "develops the condition" during hospitalization and malnutrition is 
              not identified and treated, CMS may deem it Hospital Acquired 
              Condition*
                  •  less likely to pay additional monies 
                  •  may penalize institution
                           Frequency of Malnutrition
                               Previously under recognized
                               6-51% prevalence of illness-related malnutrition in 
                                hospitalized children
                               McLaren Criteria
                                   < 4 years; MAC and HC used
                               Gomez Criteria
                                   Fails to assess proportionality of wt in relation to ht
                               FTT
                                   Decrease by 2 centiles of wt <5%tile
                               Waterlow Criteria
                                   1-3 years; acute and chronic malnutrition criteria
                         Goals of New Definition
                            Early identification of malnutrition
                            Development of uniform screening tools
                            Malnutrition prevalence comparison between 
                             studies and centers
                            Collect meaningful data
                            Development of thresholds for intervention
                            Evidence-based analysis of the impact of 
                             malnutrition and its treatment on patient outcomes