Pediatric Subjective Global Nutritional Assessment (SGNA) form

Pediatric SGNA rating form
Consider severity and duration of changes, as well as recent progression when rating each item.
Nutrition-focused medical history		SGNA score
Nutrition-focused medical history		Normal	Moderate	Severe
Appropriateness of current height for age (stunting)
Height percentile: _____	≥3^rd centile Just below 3^rd centile Far below 3^rd centile
Appropriate considering mid-parental height*?	Yes No
Serial growth^¶:	Following centiles Moving upwards on centiles Moving downwards on centiles (gradually or quickly)
Appropriateness of current weight for age (wasting)
Ideal body weight = _____ kg
Percent ideal body weight: ___ ___ ___ %	>90% 75-90% <75%
Unintentional changes in body weight
Serial weight^¶:	Following centiles Crossed ≥1 centile upwards Crossed ≥1 centile downwards
Weight loss:	<5% usual body weight 5-10% usual body weight >10% usual body weight
Change in past 2 weeks:	No change Increased Decreased
Adequacy of dietary intake
Intake is:	Adequate Inadequate - hypocaloric Inadequate - starvation (ie, taking little of anything)
Current intake versus usual:	No change Increased Decreased
Duration of change:	<2 weeks ≥2 weeks
Gastrointestinal symptoms
	No symptoms One or more symptoms; not daily Some or all symptoms; daily
Duration of symptoms:	<2 weeks ≥2 weeks
Functional capacity (nutritionally related)
	No impairment, energetic, able to perform age-appropriate activity Restricted in physically strenuous activity, but able to perform play and/or school activities in a light or sedentary nature; less energy; tired more often Little to no play activities, confined to bed or chair >50% of waking time; no energy; sleeps often
Function in past 2 weeks:	No change Increased Decreased
Metabolic stress of disease
No stress Moderate stress^Δ Severe stress^◊
Physical exam		SGNA score
Physical exam		Normal	Moderate	Severe
Loss of subcutaneous fat
No loss in most or all areas Loss in some but not all areas Severe loss in most or all areas
Muscle wasting
No wasting in most or all areas Wasting in some but not all areas Severe wasting in most or all areas
Edema (nutrition-related)
No edema Moderate Severe
		Normal	Moderate	Severe
Overall SGNA ranking

Guidelines for aggregating items into global score (overall SGNA ranking):
In assigning an overall global score, consider all items in the context of each other. Give the most consideration to changes in weight gain and growth, intake, and physical signs of loss of fat or muscle mass. Use the other items to support or strengthen these ratings. Take recent changes in context with the patient's usual/chronic status. Was the patient starting off in a normal or nutritionally-compromised state?

Normal/well-nourished
- This patient is growing and gaining weight normally, has a grossly adequate intake without gastrointestinal symptoms, shows no or few physical signs of wasting, and exhibits normal functional capacity. Normal ratings in most or all categories, or significant, sustained improvement from a questionable or moderately malnourished state. It is possible to rate a patient as well-nourished in spite of some reductions in muscle mass, fat stores, weight, and intake. This is based on recent improvement in signs that are mild and inconsistent.
Moderately malnourished
- This patient has definite signs of a decrease in weight and/or growth, and intake, and may or may not have signs of diminished fat stores, muscle mass, and functional capacity. This patient is experiencing a downward trend, but started with normal nutritional status. Moderate ratings in most or all categories, with the potential to progress to a severely malnourished state.
Severely malnourished
- This patient has progressive, malnutrition with a downward trend in most or all categories. There are significant physical signs of malnutrition-loss of fat stores, muscle wasting, weight loss >10%-as well as decreased intake, excessive gastrointestinal losses and/or acute metabolic stress, and definite loss of functional capacity. Severe ratings in most or all categories with little or no sign of improvement.

* Mid-parental height: Girls: Subtract 13 cm from father's height and average with the mother's height. Boys: Add 13 cm to the mother's height and average with the father's height. Thirteen cm is the average difference in height of women and men. For both girls and boys, 8.5 cm on either side of this calculated value (target height) represents the 3^rd to 97^th percentiles for anticipated adult height.
¶ 30% of healthy term infants cross one major percentile and 23% cross two major percentiles during the first 2 years of life, typically towards the 50^th percentile rather than away from it. This is normal seeking of the growth channel.
Δ Conditions causing moderate metabolic stress include routine surgery (such as small resection of bowel); laparoscopic surgery; exploratory surgery; fracture; minor infection (bronchiolitis, gastroenteritis); pressure sores or decubitus ulcers.
◊ Conditions associated with severe metabolic stress include major organ surgery (eg, stomach, liver, pancreas, lung, open chest, total cholecystectomy, or gastrointestinal pouch procedures); major bowel resection; trauma with multiple injuries, fractures or burns; multiorgan failure; severe pancreatitis, sepsis or inflammation; multiple deep pressure sores or ulcers; chronic illness with acute deterioration; current treatment for malignancy; acquired immune deficiency syndrome with a secondary infection; or hyperthyroidism.

Reproduced from: Secker DJ, Jeejeebhoy KN. How to Perform Subjective Global Nutritional Assessment in Children. J Acad Nutr Diet 2012; 112:424. Table used with the permission of Elsevier Inc. All rights reserved.

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Pediatric Subjective Global Nutritional Assessment (SGNA) form