Pediatric Disease Related Malnutrition (DRM)

For many different reasons, some children don't grow at the rate they should do. Normal development in childhood is essential for wellbeing as we get older. Achieving normal development starts with nutrition.

Sometimes there is no known cause for faltering growth, and a child just needs extra nutritional support in early life in order to meet their nutritional needs. In other cases, childhood growth can be affected by a number of medical conditions.1,2 In these cases, a child may require medical nutrition to allow them to grow and develop normally. It can be challenging to ensure that children with faltering growth get all the nutrients they need, for example, if feeding and eating are difficult, or because they aren't able to absorb nutrients in the right amounts.

Welcome to the healthcare professional pages of Pediatric disease related malnutrition (DRM), where you'll find more details on the topic, as well as relevant links to clinical guidelines, feature articles, including information about a new screening tool (Feeding Nutrition Screening Tool - FNST) that can help identify nutritional risk in children with cerebral palsy.

About medical nutrition

Normal growth for children starts with meeting their nutritional needs5,6

Appropriate growth starts with meeting children’s nutritional needs

There are a number of reasons why some children can have difficulties growing optimally, including the presence of an underlying disease or condition such as cerebral palsy, congenital heart disease (CHD), cystic fibrosis, liver disease or cancer. Poor growth can have a detrimental effect on both short and long-term health outcomes.

For example, infants and children with CHD who have low weight pre-surgery are known to have poorer surgical outcomes or even have their essential surgery delayed4-6. Whether disease-related or not, chronic poor weight gain during early life is associated with long-term consequences, including stunting and permanent alterations in brain growth and function, leading to cognitive and behavioral impairment7-10. Appropriate growth and development start with nutrition, however achieving adequate nutrient intake can be challenging in this population – providing appropriate nutritional management solutions tailored to the child’s needs is essential to support their growth and development.


Clinical Guidelines


ASPEN (American Society for Parenteral and Enteral Nutrition) recently published a new healthcare provider fact sheet to support the nutritional management of children with growth failure. The document is titled “Nutrition Management of term infants with growth failure” and in some cases with poor growth the recommendation is to add an energy and nutrient dense infant food for special medical purposes up to 100% in addition to breastmilk.

Nutritional management of children with Cerebral Palsy

A third of children with cerebral palsy (CP) are undernourished11 which can have a negative effect on their health outcomes. Ensuring these children meet their required nutritional intake can be very challenging, especially for children with more complex needs12 and can put a burden on the quality of life of these families.

Feeding difficulties in children with cerebral palsy: why they matter and how to recognize them

Children with cerebral palsy often have difficulties with feeding and swallowing. These can cause children to become underweight and undernourished, with consequences for growth and development. The Feeding and Nutrition Screening Tool can help parents screen for risk of feeding/swallowing difficulties and undernutrition quickly and easily, so they know when to seek medical help.

Nutritional screening tool

Accurately measuring the nutritional status of these patients is essential to ensure these children get the nutritional intake they need to grow. That’s why Nutricia developed an online screening tool called the Feeding and Nutrition Screening Tool (FNST), the first scientifically validated online screening tool for early identification of feeding/swallowing difficulties and undernutrition in children with CP. By answering only four questions, this tool can help parents to identify risk of undernutrition and feeding/swallowing difficulties and help ensure children get adequate nutrition to meet their needs. 

Access Expert Education at Nutricia Academy

Danone Nutricia Campus: Faltering Growth

Faltering growth can affect both an infant or child’s short and long-term health - with consequences including an increased risk of infections, poorer recovery from surgery, prolonged length of intensive care stay and GI dysfunction in the short-term and impaired lung and cardiac function, compromised cognitive achievements, stunting and poorer lifelong health in the longer term.

The importance of nutritional support

Optimal nutritional support for a child with growth challenges will depend a lot on their age and their condition. Find out more about the importance and goals of nutritional support for these children.

Nutritional solutions tailored to individual needs

Children with different growth challenges may have quite different nutritional requirements to each other. Their requirements often also depend on the age and weight of the child. 

  1. Mehta et al. JPEN 2013: 37(4):460-481.
  2. Beer et al. Nutr Clin Practice 2015;30:609-624.
  3. Hecht et at. Clin Nutr 2013:34:53-59
  4. Curzon et al 2008
  5. Kogon et al 2008
  6. Wallace et al 2011
  7. Chang et al 2016
  8. El-Sherif et al 2012
  9. Galler et al 2012
  10. Jan 2020
  11.  Vitrikas K, Dalton H, Breish D. Am Fam Physician. 2020;101(4):213-20
  12. Clin Nutrition 2020
  13. Fung EB, Samson Fang L, Stallings VA, et al. J Am Diet Assoc 2002; 102: 361–73. 
  14. Samson-Fang L, Fung E, Stallings VA, et al. J Pediatr 2002; 141: 637–43. 
  15. Bell KL, Benfer KA, Ware RS, et al. Dev Med Child Neurol. 2019;61(10):1175-81.

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