Don't forget the undernourished children in our midst

Despite the UK's obesogenic environment, undernourished children still exist and need to be identified so that they can receive the nutritional support they require for healthy growth and development. Undernourished children have an impaired immune system that predisposes them to infection and slower recovery, and depletion of their muscle mass can affect functional capacity. The use of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), a new tool developed at Manchester Children's Hospitals is discussed. This involves a rapid, simple and validated method for ward nurses to identify children at nutritional risk on admission to hospital. Results have been reliable and reproducible when compared to a full nutritional assessment by a registered paediatric dietitian. At-risk children are referred to a paediatric dietitian or nutritional team for dietetic support. Piloting indicated a need for new weighing and measuring equipment and regular calibration to ensure accurate results. Many hospitals rely on old equipment that is not regularly calibrated. STAMP could be extended to other hospitals in the UK and could be adapted as a tool for measuring and assessing undernourished children in the community. However, nurses using it during the pilot scheme were reluctant to plot growth and BMI centile charts and instead relied on using figures supplied by the tool's ready reckoner which they matched to categories of low, medium or high nutritional risk. It can be argued that height and weight assessment of children is the most non-invasive way of assessing health and well-being in a child and that all health care staff should be competent in this task. Few opportunities appear to exist for training, hence the development of an alternative approach by the Infant and Toddler Forum. This takes the form of a self-learning tool to enable health staff to acquire skills and confidence in measuring and in plotting and interpreting growth and BMI centile charts. This tool can be used as part of continuing professional development for health and child care professionals.