Failure to thrive (FTT) refers to a condition where a child’s physical growth does not meet the expected standards compared to their peers. This is typically caused by not receiving the necessary nutrients to meet their individual nutritional needs, resulting in anthropometric parameters falling below the 5th percentile. [1] FTT can be attributed to various factors, including insufficient oral intake (such as eating disorders, lack of food, or developmental delay), inadequate nutrient absorption (such as cystic fibrosis, chronic inflammatory bowel disease, or burns), increased metabolic demands (such as chronic lung disease and cardiac failure), or a combination of these conditions. [2] [3]

A retrospective study on 497 patients found that 59% experienced FTT due to inadequate intake, 20% due to organic causes, 11% due to mechanical feeding issues, and 10% had mixed or unexplained diagnoses. [4] Malnutrition is believed to be common in hospitalized children due to heightened metabolic requirements resulting from their present illness, reduced appetite, concurrent medication usage, and inadequate dietary intake during treatment. [5] [6] Nevertheless, the identification of malnutrition might be impeded by discrepancies among different populations and patients, the utilization of various diagnostic instruments, and the absence of agreement over the definition of malnutrition.

A cross-sectional study was conducted in Egypt, involving 500 hospitalized patients under the age of 3. The nutritional status of these patients was evaluated using the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids). The results showed that 37.8% of the patients were classified as being at high risk for malnutrition, 42.6% had a moderate risk, and 19.6% had a low risk. [7] An Iranian study examined the occurrence of malnutrition in hospitalized patients aged 1 month to 18 years, using BMI Z score and WHO cut-off criteria for children. The findings revealed that upon admission, 35% of the patients were identified as malnourished, with 21% classified as mild, 3% as moderate, and 10% as severe. [8] A study conducted in Malaysia measured anthropometric parameters, including weight, length/height, mid-upper arm circumference (MUAC), and triceps skinfold thickness, in 285 children aged 3 months to 15 years. The study found that the prevalence of acute undernutrition was 11% and chronic undernutrition was 14%. [2] In addition, a study conducted in Spain revealed that the frequency of malnutrition among pediatric patients in hospitals was 8.2%. [9] Another study conducted in Spain also reported similar findings. The incidence of malnutrition was 7.1% for mild cases and 0.7% for severe cases of acute malnutrition. The prevalence of moderate chronic malnutrition was 2.7%, whereas the prevalence of severe chronic malnutrition was 1.4%. [10]

Still a major worldwide health concern, malnutrition affects children in many different areas, having major consequences for their development and growth. Research conducted in Yemen, [11] Senegal, [12] India, [13] and Myanmar [14] emphasizes how common and varied malnutrition is. Primary school children in Myanmar must deal with both undernutrition and overnutrition, which suggests the need for thorough public health campaigns. [14] Poor dietary diversity and socioeconomic issues cause high rates of malnutrition among newborns in Dakar, Senegal’s suburbs. [12] Likewise, poor nutrition and limited access to healthcare aggravate severe acute malnutrition (SAM), which is common among youngsters in Mumbai, India, [13] and Aden, Yemen. [11] We advocate for the inclusion of systematic screening for nutritional status as a standard component of routine assessments during hospitalization. [5] [6] The objective of our study is to conduct a comprehensive assessment of the growth and nutritional condition of every child admitted to the pediatric ward at King Abdullah University Hospital (KAUH) upon their admission. Our goal is to determine the prevalence of undernutrition among hospitalized children and identify the associated factors with being undernourished.

Our primary goal was to assess the nutritional status of children aged 2 months to 16 years admitted to the pediatric ward at KAUH. We aimed to determine the incidence of malnutrition among these patients and identify the risk factors contributing to undernutrition, facilitating early detection and intervention. Our research showed that 19.8% of hospitalized patients were malnourished, while 3.6% were obese.

In our cohort, the prevalence of malnutrition was 19.8%, nearly double the rate reported in Spain, where a study of 852 patients admitted to a tertiary hospital found an 8.2% prevalence of malnutrition. This Spanish study associated malnutrition mainly with nervous and respiratory diseases, comprising 45.8% of cases [10] . Conversely, a study at Mofid Children’s Hospital in Tehran found a 35% malnutrition prevalence at admission using BMI Z scores based on WHO cutoffs [8] . In Thailand, a prospective cohort study conducted between December 2018 and May 2019 across four tertiary care hospitals found an overall malnutrition prevalence of 44.5% [16] .

In Malaysia, anthropometric measurements of 285 children aged three months to 15 years revealed rates of 11% for acute undernutrition and 14% for chronic undernutrition [9] . These variations in prevalence can be attributed to differences in populations, patient types, assessment tools, and definitions of undernutrition in children.

Based on the definitions of underweight and stunting (Z-scoreless than −2), we found that approximately 14% of patients were stunted, and 12% were underweight. In contrast, Shaaban et al. reported higher prevalence values in their study on nutritional risk screening of hospitalized children aged between 1 and 36 months at the Children’s Hospital, Ain Shams University, Cairo, Egypt, finding that 57.8% were underweight and 58.4% were stunted based on WHO definitions [7] . A prospective study of 117 children admitted for scheduled elective general surgical procedures in a Nigerian tertiary hospital found similar results to ours, reporting that 14.5% were undernourished and 11.1% were stunted [17] .

The similarity between our results and the second study may be attributed to similarities in the studied age groups and sample sizes, unlike the first study which involved a different age range and possibly different sample characteristics.

In our cohort, half of the patients with growth impairment had known chronic medical issues. This finding aligns with Prasadajudio et al.’s findings of growth impairment rates in children with chronic illnesses in developing countries. They concluded that malnutrition prevalence in pediatric hospital patients might be underestimated and often begins before admission. Their study revealed that patients with chronic illnesses, especially those with cardiac and renal problems, had the highest malnutrition rates [18] .

Based on the definition of nutritional anemia (Hemoglobin < 11 and RDW > 16), 14 out of 111 patients (12%) were found to be anemic. Consistent with our findings, a study on the prevalence of malnutrition and its correlates among children undergoing elective general surgical procedures in a tertiary hospital in a developing country reported that 16.2% were anemic [18] .

In contrast, Saengnipanthkul et al. found that 32.7% of patients without underlying hemolytic disorders or cancer were anemic in a multi-site tertiary medical center study in Thailand. This discrepancy may be due to their larger sample size compared to ours, in addition to population-related factors [16] .

While examining the associations between nutritional history, family perception of child growth, and the prevalence of malnutrition, our study found no relation between breastfeeding history and growth retardation. This aligns with a study conducted at a single hospital in Malaysia [9] , but the results are not generalizable due to the small sample size and inherent recall bias.

Interestingly, mothers’ perception of their children having malnutrition correlated well with actual malnutrition. This finding is consistent with a previous Turkish study that reported a good correlation between maternal estimation of a child’s weight and growth [19] . Such insights can serve as useful indicators for further assessment when rapidly evaluating child growth. Asking about parental perception of a child’s growth might signal the need for additional evaluation.

We found that malnutrition prevalence in admitted pediatric patients at KAUH is 19.8%. However, the major drawbacks of our study are the small sample size, which limits the ability to draw definitive conclusions, and the fact that it was conducted in a tertiary referral hospital. This setting likely selected a specific population of children with chronic and potentially complex illnesses, making the generalization of the results more difficult. To address these limitations, a multicenter, prospective study utilizing a broader range of assessment tools is necessary. This approach would provide a more representative sample and enhance the reliability and applicability of the findings.