STRONGkids screening tool for assessment of nutritional risk in hospitalized children

1. High risk disease (Yes = 2 points) Is there an underlying illness with a risk of malnutrition* or expected major surgery? Subjective clinical assessment (1 point) Is the patient in a poor nutritional status judged by subjective clinical assessment (diminished subcutaneous fat and/or muscle mass and/or hollow face)?
2. Nutritional intake and losses (Yes = 1 point) Are one of the following items present? Excessive diarrhea (≥5 per day) and/or vomiting (>3 times/day) the last few days? Reduced food intake during the last few days before admission (not including fasting for an elective procedure or surgery)? Pre-existing dietetically advised nutritional intervention? Inability to consume adequate intake because of pain?
3. Weight loss or poor weight gain? (Yes = 1 point) Is there weight loss or no weight gain (infants <year) during the last few weeks/months?
Interpretation: Risk for malnutrition and need for intervention (per Hulst et al, 2010)
4 to 5 points	High risk	Consult doctor and dietician for full diagnosis and individual nutritional advice and follow-up. Start prescribing sip feeds until further diagnosis.
1 to 3 points	Medium risk	Consult doctor for full diagnosis; consider nutritional intervention with dietician. Check weight twice a week and evaluate the nutritional risk after one week.
0 points	Low risk	No intervention necessary. Check weight regularly per hospital policy, and evaluate the nutritional risk after one week.

* High risk disease includes anorexia nervosa, burns, bronchopulmonary dysplasia (maximum age two years), celiac disease, cystic fibrosis, dysmaturity/prematurity (up to corrected age six months), cardiac disease (chronic), infectious disease (eg, AIDS), inflammatory bowel disease, cancer, liver disease (chronic), kidney disease (chronic), pancreatitis, short bowel syndrome, muscle disease, metabolic disease, trauma, intellectual disability, expected major surgery, not specified (classified by doctor).

Reproduced from: Hult JM, Zwart H, Hop WC, Joosten KFM. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clinical Nutrition 2010; 29:106. Table used with the permission of Elsevier Inc. All rights reserved.

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STRONGkids screening tool for assessment of nutritional risk in hospitalized children