Undernutrition is a more serious risk in the United States than many realize. Studies have shown that 1 out of every 8^* children in the US have at least 1 indicator for undernutrition.¹ This problem is amplified when we consider the significant role that nutrition plays in a child’s physical and cognitive development. We will explore the negative effects of undernutrition as well as factors to consider when assessing the risk of growth faltering.

Consequences of Undernutrition: Physical Growth and Beyond

The correlation between poor nutrition and slow physical growth may seem apparent, but it’s not the only consequence of children receiving inadequate nutrition. Undernutrition can:

• Deplete the body’s resources and increase susceptibility to common illnesses²
• Negatively affect cognitive development and impact how children perform academically^3,4

Children of many different races, income levels, and genders suffer from undernutrition.¹ As practitioners, we need to be able to identify when a child’s growth is faltering and intervene before more pronounced developmental issues are realized. Intervention will be necessary to ensure the child achieves optimal growth and development.

Risk Factors for Growth Faltering 

Although the most common cause of growth faltering is lack of caloric intake, medical conditions can impact growth as well. Providing proper treatment depends on proper diagnosis; the following factors can help us identify the cause of undernutrition in our patients.

Consider negative anthropometric trends. Measuring and tracking growth trends can reveal underlying health issues. The following trends may be signs of undernutrition^5,6:

• Loss in body weight
• Decline in 1 z-score for weight-for-height or BMI-for-age

Consider possible conditions. The following 3 categories and associated underlying conditions can increase the risk of growth faltering:

• Decreased caloric absorption: Celiac disease or gluten sensitivity, food allergy, malabsorption, cystic fibrosis, chronic kidney disease
• Increased caloric expenditure: Chronic infection, pulmonary or heart disease, oncology-related side effects, burns/trauma
• Medical conditions: Premature infants, hospitalized children, children with special healthcare needs

Possible Resolutions

If you have identified that your patient has daily caloric deficit, here are some possible resolutions:

• Increased food intake
• Oral nutritional supplements (ONS)
• A combination of both

If your patient struggles to eat a variety of foods, increasing food intake may be difficult, as key nutrients needed for catch-up growth are hard to get from high-calorie foods alone. Optimal growth is best achieved when using a combination of dietary counseling and ONS.⁷ ONS not only supply essential nutrition for physical growth and cognitive development,⁸ but also come in the form of flavorful shakes that most children enjoy. It is important to remember that ONS do not replace table food consumption, but actually lead to increased food consumption over time.⁹ Combined with dietary counseling, ONS can help correct undernutrition and get your patient’s growth and development back on track.

* Health and Nutrition Examination Survey (NHANES) data were analyzed from 2005 to 2014 for the prevalence of undernutrition in US children aged 1–13 years. The anthropometrics from 13,950 children were characterized as z-scores using 2000 Centers for Disease Control and Prevention (CDC) growth charts. These z-scores were categorized according to the recent ASPEN/AND definition of malnutrition/undernutrition. The prevalence of undernutrition combining mild/moderate/severe totaled 13.4% of the children analyzed, which equals approximately 1 in 8 children with at least 1 indicator for undernutrition. The prevalence of moderate and severe undernutrition together totaled 2.4%, which equals approximately 1 in 40 children having at least 1 indicator in the moderate or severe category for undernutrition.

References: 1. Price AA, et al. Nutrients. 2020;12(5):1409. 2. Bresnahan
KA, et al. Adv Nutr. 2014;5(6):702-711. 3. Black RE, et al. Lancet. 2013;382(9890):427-451. 4. Victora CG, et al. Lancet. 2008;371(9609):340-357. 5. Becker P, et al. Nutr Clin Pract. 2015;30(1):147-161. 6. Murray RD. Pediatr Ann. 2018;47(11):e465-e469. 7. Alarcon PA, et al. Clin Pediatr. 2003;42:209-217. 8. Bourre JM. J Nutr Health Aging. 2006:377. 9. Huynh DT, et al. J Nutr Sci. 2016;5:e20.