Tag: failure to thrive

Malnutrition Defined


Everyone knows a few “nutrition-specific” words, like protein, vitamin and carbohydrate. Dietitians have very specific definitions of such words that are often quite different than the general public’s understanding. Malnutrition is one of those words. Malnutrition can be a scary word that brings up images of bone thin children with large bellies. Those images are examples of a very severe form of malnutrition rarely seen in the United States. Hearing the word malnutrition can catch parents off guard,  especially since failure to thrive has been the more familiar descriptive term in the recent past.

The Academy of Nutrition and Dietetics and the American Academy of Pediatrics follow the same guidelines for identifying and categorizing malnutrition.  We follow those same guidelines here at the NC Children’s Hospital. Diagnosing malnutrition and categorizing its level (mild, moderate or severe) is a critical part of developing a nutritional care plan for each individual patient.  We do our very best to incorporate everything we know about a child before assigning that child with the diagnosis of malnutrition. Our guidelines tell us to take medical conditions, questions about accuracy of measurements and recent illnesses all into consideration before diagnosing malnutrition.

In children, malnutrition is identified using several difference pieces of information and is based on the child’s age. Slightly different for children under age two, we generally assess the following:

  • How much weight is gained compared to the ideal amount for a child his/her age
  • How much a child weighs compared to his/her height
  • Weight loss relative to usual weight
  • Height or length for age
  • At times, we also measure a mid-upper arm circumference (MUAC) and compare it to the ideal MUAC for a child of the same age

So that we make consistent comparisons, we use a statistic called a z score. The z score not only provides cut off information about whether or not a child is likely to be malnourished, but also the degree of malnutrition. Z scores are very useful because they give us much more concrete comparisons for growth information over time rather than looking solely at standard growth percentiles. We can see shifts in z scores sooner than changes in growth percentiles. This helps us, and you, know if our plans are effective.

As we hope you can see through this description, malnutrition is a much more specific term than its predecessor, “failure to thrive”.  Failure to thrive simply means that a child is not growing adequately compared to a standard growth chart. This alone is not enough information to plan and monitor treatment.

Although the word malnutrition may feel negative, it really is a positive way for medical providers to communicate, identify and track the success of our treatments so that we can provide the best care possible.

Written by Lisa Richardson, one of our highly trained Pediatric Dietitians.

A Word of Encouragement from our Dietitians


In her book First Bite, Bee Wilson wrote, “Seeing a child fed reassures you that you have done your duty as a parent, like a mother bird ferrying worms to the nest.”

Unfortunately, parents of children with feeding challenges miss that regular reassurance, which can leave them feeling frustrated and unsuccessful in parenting their child. Then, parents come into the feeding clinic and the dietitian asks, “What does your child eat?”  Parents, particularly those new to our clinic, take a deep breath and sometimes even look away before answering. In that pause between question and response, it seems parents hear a different question: “How good of a parent are you?”

Similarly, the medical words we use can sometimes feel negative. Malnutrition is one of those words. Providers use medical terms to communicate quickly and specifically with one another.  But, “malnutrition” isn’t specific to medicine and the word can bring up images of children who are being starved on purpose. We use the term very specifically as it medically defined by national organizations (more about that in our next post so stay tuned!!). This is a much more specific word than “failure to thrive,” because malnutrition is defined by specific growth parameters. Indeed, the word failure is not exactly helpful in understanding feeding problems. In most cases, by the time families encounter our team, they have been creative and persistent in the face of very big feeding challenges (“Ferrying worms to the nest”).

Please know that our questions are to gather information – not to judge you! The primary purpose for the dietitians on the team is to craft best strategies for each unique child to be well-fed and to thrive, often using formulas and alternative ways of feeding. Asking about what your child eats and classifying his/her nutrition status, helps the dietitians to formulate best ways to help your child. Our ultimate goal is that each of our parents will feel the reassurance of that mother bird ferrying worms to the nest.

Written by Lisa Richardson, one of our highly trained Pediatric Dietitians.