Nutrition to support care of the most vulnerable

Published: 07-02-2014, | Member: National Sports Centre Papendal

The question is an important one, for both Nutricia and for those children at risk. Even strong science and the most highly specialized nutrition will not help a patient if clinical practice is delivering the solution at the wrong time, or at an insufficient level.

Screening programs show that high numbers of admitted child patients are already acutely undernourished, especially in the cardiac, renal, and neurology wards, because of the nature of their disease. But the stressful circumstances of a hospital stay can often exacerbate this problem, just when specialized nutritional support is needed the most. In studies conducted since 2006 in the Netherlands, Italy, and Brazil, as many as half of all children admitted to a hospital have lost weight during their stay. This is sometimes referred to as hospital-related malnutrition, and it can be costly—delaying a child’s recovery and his or her normal path to growth, and resulting in a longer and more expensive hospital stay.

But which patients will benefit most from specialized intervention, and when? To help answer this question, the pediatric teams at Nutricia Netherlands have been working closely for the last five years with a team led by Dr. Koen Joosten of the Erasmus Medical Centre—Sophia Children’s Hospital in Rotterdam. Together they’ve been developing better ways to identify and manage children at risk of malnutrition in hospital care.

The core challenge for the teams was to find a simple and pragmatic screening tool that could be deployed in the hospital—especially at the admission stage—to assess the nutritional status of child patients, and to predict the risk of a child developing malnutrition while in care. What Dr. Joosten and his team wanted was a tool that could predict risk reliably, determine when nutritional intervention was most crucial, and deliver the most benefit. The research team came up with a “5-minute” screening tool, which they named STRONGkids: the Screening Tool for Risk of Impaired Nutritional Status and Growth.

The tool is simplicity itself, relying on a five-point score generated from four items:

  • a subjective assessment of the child’s condition (fat, muscle, hollow face?): 1 point
  • recent history of weight loss (or inadequate weight gain in infants): 1 point
  • diarrhea/vomiting, loss of appetite or inability to eat: 1 point
  • underlying serious illness or expected major surgery: 2 points

Children scoring 4–5 points are considered High Risk, and are referred for a full assessment and professional nutritional advice; children scoring 1–3 points are placed on watch, to be weight-checked twice a week, and regularly re-screened.

In a very short time, Dr. Joosten’s STRONGkids risk assessment has turned out to be something of a “power tool.” In the Netherlands, more than half of all hospitals have chosen to implement the tool as a routine process, and have integrated it into their digital patient information system. The Dutch Health Care Inspectorate also uses it as a performance indicator. In 2011, 52% of all children admitted to hospitals (more than 100,000 patients) were screened, with 9% found to suffer from acute malnutrition. As a result, follow-up and specialized nutritional care are now not only given as part of treatment, but are also measured and tracked.

The STRONGkids approach has also gained acceptance across the Dutch border in Belgium, and has been introduced in teaching and other hospitals in 12 other European countries.

“The long-term consequences of under-nutrition in children cannot be underestimated,” says Dr. Joosten. “They include not only negative effects on normal physical growth, but also can result in impaired development of the brain, with the risk of attention deficits and behavioral difficulties, and of disease in adult life. I am glad that the STRONGkids program has contributed to raising the awareness of this problem, and that it has led to better management of the nutritional needs of children in the care setting.”

Contact details:
Mr. William Green
Director Public Affairs & Relations
Nutricia Advanced Medical Nutrition
Danone Place Schiphol
Websites: or Dutch website