screening criteria for Low birth weight children in malnutrition

Dear Naapong,

This is a difficult one and I'd be curious to find out what other people do.

MUAC is unreliable in this age group and I've always heard that height shouldn't be used for this in a child until they are standing, as the length of a child is not consistent when they are lying down.

Instead, I'd plot the weight according to age (corrected for prematurity) to identify and then monitor malnutrition. I usually use these WHO charts:

- http://www.rcpch.ac.uk/system/files/protected/page/GIRLS%20NICM%20(4th%20Jan%202013).pdf
- http://www.rcpch.ac.uk/system/files/protected/page/BOYS%20NICM%20(4th%20Jan%202013).pdf

Identification
If I thought a child was malnourished but I didn't have their birth weight, I would plot them on the WHO centile charts. Then you would get idea of how they compare to a similar cohort. i.e. if they are <0.4th centile. However these charts are notoriously based on a small and non-ethically diverse sample, therefore difficult to know how useful.

Monitoring
For LBW / premature following birth, they should be gaining 10-20g/kg/d (this varies in the literature), so if they are measured as not gaining this weight then I would classify them as FTT (failure to thrive) or poor weight gain, whatever the reason. I would follow this until they reach their birth weight (this unfortunately only works if you know their birth weight).

If you are monitoring them over a period of time, I normally use the centile charts to monitor their weight. They should follow a centile line (doesn't really matter which one as long as they're following it). Normally I follow the rule that they should be following their centile and if they fall across at least 2 centiles then there is a problem and they are again FTT / malnutrition.

I hope this helps, but would be useful to find out what others do.

Many thanks for your message and apologies for the typo. Reflecting on your feedback, it is important that I clarify that I was sharing some personal experiences of treating this age-group.

- I have found practically speaking that there was a huge amount of variability in measuring length in nutrition programmes. Therefore we have chosen in some programmes not to use it in the <6 months. However this was a field decision and shouldn't detract from WHO recommendation of using length when assessing.

- a discussion we have had in the field is regarding the applicability of tools when designed based using other ethnic groups. The WHO tools (background information here: http://www.who.int/childgrowth/publications/technical_report_velocity/en/) are commonly used / adapted and have been widely discussed. Places I have worked have been ethnically very diverse and so we have discussed that there may be some difference from tools designed from data in other countries / with other backgrounds.

- the <0.4th centile was an example used due to difficulties faced of not knowing the birth weight. I have worked in European settings where centiles are used and so drew on what was familiar to me as an example; I appreciate your point about this being a ‘late’ cut-off. This was not intended as an absolute, but as an open discussion regarding how to approach this problem. When reviewing a child < 6 months for malnutrition I found that it was rare to know the exact gestational age at birth, or even correct birth date in many of the contexts I have worked in.

Many thanks for your comments and apologies for lack of clarity.