Infant Malnutrition Clinical Pathway — Outpatient Specialty Care and Primary Care

Review of Systems Screening

History, review of systems and physical exam will guide the differential diagnosis, the risk of malnutrition and management.

Evaluate for signs of weight loss caused by infection, GI illness, or inadequate caloric intake.

General	Detailed birth history (gestational age, weight) Overall findings of malnutrition (e.g. cachectic appearance, hydration status, decreased subcutaneous stores, decreased muscle bulk, relative macrocephaly) Fevers Lack of caregiver bonding or responsiveness to infant Dysmorphic/congenital anomalies
HEENT	Feeding difficulties Jaundice or scleral icterus Nasal congestion or obstruction Cleft lip or palate Macroglossia Ankyloglossia Micrognathia
Respiratory	Stridor or Stertor Difficulty breathing Tachypnea Abnormal breath sounds (e.g. wheezing, crackles) Chronic/recurrent cough, wheezing or PNA
Cardiac	Sweating and/or fatigue with feeds Murmurs Diminished or absent peripheral pulses Pre/Post ductal pulse ox
GI	Hepatosplenomegaly Abdominal distension Vomiting/reflux symptoms Abnormal stools: constipation, blood, mucous, diarrhea, steatorrhea
Skin	Skin abnormalities (e.g. rash, diaper area/skin breakdown, severe atopic dermatitis)
Neurologic	Depressed mental status, inconsolability and/or sleepiness Developmental delay/regression Abnormal movement Seizures
Immunology	Recurrent bacterial infections Serious or unusual infections Chronic eczema Chronic lymphadenopathy Chronic diarrhea

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.