The first screening tool in Scotland to identify children at risk of malnutrition has been developed at the Royal Hospital for Sick Children at Yorkhill.
Based on a simple scoring system, the Paediatric Yorkhill Malnutrition Score (PYMS), will flag up children aged from one year upwards who may be at nutritional risk to health care professionals.
Consultant Paediatric Gastroenterologist Diana Flynn said: “What prompted us to look at nutritional screening was that while it had been developed for adults in hospitals there was very little for children.
“The tool is not only to screen for malnutrition but also to assess if patients are at risk of developing nutritional problems, as there is currently no good single measure to assess risk. For example they may have difficulty absorbing food because of their medical condition which might only be detected later when the child had lost weight.”
The system collates information routinely collected from nursing assessment, including height and weight and the child’s dietary intake following five steps, the final step providing the total nutritional risk score.
If a child is eating well with normal height and weight and no other risk factors they will score 0.)
A patient will score 1 if they have unintentionally lost weight, have a decrease in their intake or have ongoing diarrhoea or vomiting, or have a very low body mass index. A score of 2 may be due to a combination of these.
This can be useful in children who have already lost weight and are facing major abdominal surgery where their intake is likely to be decreased further.
Patients can also be scored if they have increased energy requirements for example if they are recovering from burns where higher levels of nutrition are required to help them repair the damage.
If a score of 2 or more is recorded, then a dietetic review of the patient is carried out to ensure nutritional intake remains optimal, the medical/surgical team are informed, and the PYMS is repeated weekly.
The effects can be long lasting, went on Dr Flynn: “A high risk of undernutrition can contribute to increased hospital stay and increased risk of infections . In the long term, malnutrition can have an impact on growth and development, with children only achieving suboptimal height. In addition, specific deficiencies in iron levels can affect intellectual abilities at school, and vitamin deficiencies can lead to severe consequences.”
There has already been interest from around Scotland in the Yorkhill “score”, which is also being implemented in children’s wards at the Southern General and Royal Alexandra Hospitals.
The PYMS tool is important as simply measuring height and weight does not tell you if the child is going to be at high risk of needing nutritional support. It builds on rather than replaces current height and weight measurements and does not replace clinical judgement.
Dr Flynn added: “What the PYMS tool does do is recognise potential nutritional problems more effectively and at a earlier stage and allows dieticians to provide earlier nutritional advice and give more details about the patient’s nutritional condition to the medical team.”
For further information contact NHS Greater Glasgow and Clyde Communications on 0141 201 4429.