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RXNPD100349
STAMP, the Screening Tool for the Assessment of Malnutrition in Paediatrics, provides a simple way of determining whether a child is at risk of malnutrition STAMP also provides guidance to help you develop a care plan according to the childs overall risk of malnutrition STAMP is made up of 5 simple steps, which are detailed on the following page Please note that STAMP is designed only for use with children in hospitals, and does not detect deficiencies or excessive intakes of vitamins and minerals To complete a STAMP screening, you will need to print out a STAMP screening form and diagnosis table from www.stampscreeningtool.org please keep these with the childs medical notes In addition to the screening form and diagnosis table, you will also find weighing and measuring instructions and centile quick reference tables on the website, which may be useful when completing a STAMP screening You can also download a step-by-step guide to using STAMP from the website However, before you conduct your first STAMP screening, please make sure that you read and understand the instructions on the following page If you have any queries, please visit www.stampscreeningtool.org and click on the Information or Contact us buttons at the top of the web page
STAMP should be used in association with Trust referral guidelines and policies
Step 2 Nutritional intake Use your knowledge of the childs eating habits to determine their nutritional intake. If necessary, speak to other Healthcare Professionals and the parent/carer to find out more. Assign a score according to the childs current nutritional intake, and progress to step 3. What is the childs nutritional intake? None Recently decreased/ poor No change/good Score 3 2 0
Step 3 Weight and height Weigh and measure the child using the weighing and measuring instructions provided. Use the centile quick reference tables on the website or a growth chart to determine how many columns/centiles apart the height and weight are. Then progress to Step 4. Use a growth chart or the centile quick reference tables to determine the childs measurements > 3 centile spaces/ 3 columns apart (or weight < 2nd centile) > 2 centile spaces/ = 2 columns apart 0 to 1 centile spaces/ columns apart
2010 Central Manchester University Hospitals NHS Foundation Trust
Score
3 1 0
Step 5 Care plan Once you have calculated the childs overall risk of malnutrition, develop a care plan for the child in accordance with local guidelines. Repeat screening as recommended on the STAMP screening form. Develop a care plan based on the childs overall risk of malnutrition High risk Take action Refer to a Dietitian, nutritional support team or consultant Monitor as per care plan medium risk Monitor nutritional intake for 3 days Repeat STAMP screening after 3 days Amend care plan as required Low risk Continue routine clinical care Repeat STAMP screening weekly while child is an in-patient Amend care plan as required
STAMP should be used in association with Trust referral guidelines and policies
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RXNPD100217
Step 1 Diagnosis Does the child have a diagnosis that Score has any nutritional implications? Definitely Possibly No 3 2 0
Step 2 Nutritional intake What is the childs nutritional intake? None Recently decreased/poor No change/good Score 3 2 0
Step 3 Weight and height Use a growth chart or the centile quick reference tables to Score determine the childs measurements > 3 centile spaces/ 3 3 columns apart (or nd weight < 2 centile) > 2 centile spaces/ 1 = 2 columns apart 0 to 1 centile spaces/ 0 columns apart
Step 4 Overall risk of malnutrition Add the scores from steps 13 together to calculate the overall risk of malnutrition High risk Medium risk Low risk
Score 4 23 01
Step 5 Care plan Develop a care plan based on the childs overall risk of malnutrition High risk Take action Refer to a Dietitian, nutritional support team or consultant Monitor as per care plan Medium risk Monitor nutritional intake for 3 days Repeat STAMP screening after 3 days Amend care plan as required Low risk Continue routine clinical care Repeat STAMP screening weekly while child is an in-patient Amend care plan as required
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RXNPD100216
Step 1 Diagnosis
Does the child have a diagnosis that has any nutritional implications? Definite nutritional implications Possible nutritional implications No nutritional implications What is the childs nutritional intake? No nutritional intake Recently decreased or poor nutritional intake No change in eating patterns and good nutritional intake Use a growth chart or the centile quick reference tables to determine the childs measurements > 3 centile spaces/ 3 columns apart (or weight < 2nd centile) > 2 centile spaces/= 2 columns apart 0 to 1 centile spaces/columns apart Add up the scores from the boxes in steps 13 to calculate the overall risk of malnutrition High risk Medium risk Low risk What is the childs overall risk of malnutrition, as calculated in step 4? High risk Score 3 2 0 1st screening 2 nd screening 3rd screening
Medium risk
Low risk
Please complete after each screening 1st screening 2nd screening 3rd screening
Diagnosis table
To be used to assign a score for step 1 of STAMP
Definite nutritional implications Bowel failure, intractable diarrhoea Burns and major trauma Crohns disease Cystic fibrosis Dysphagia Liver disease Major surgery Multiple food allergies/intolerances Oncology on active treatment Renal disease/failure Inborn errors of metabolism
Possible nutritional implications Behavioural eating problems Cardiology Cerebral palsy Cleft lip and palate Coeliac disease Diabetes Gastro-oesophageal reflux Minor surgery Neuromuscular conditions Psychiatric disorders Respiratory syncytial virus ( RSV ) Single food allergy/intolerance
While every effort has been made to include diagnoses that have nutritional implications, this list is not exhaustive If you have any queries, please discuss them with a Dietitian
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Preparing to weigh an infant or child Ensure the scale is on a flat, hard, even surface. Make sure the power source is turned on. Explain all procedures to the parent/carer. Infants should be weighed unclothed. Children should be weighed wearing minimal clothing. Make sure the scale display reads 0 prior to use. All weights and measures should be checked for accuracy and calibrated regularly. To maintain hygiene, wipe the scale down between weighings. Tared weighing: for infants <2 years old or children who wont stand still The parent/carer should stand barefoot in the middle of the scale with feet slightly apart, and remain still until his/her weight appears on the display (Figure 1). Note the weight of the parent/carer. Hand the unclothed infant to the parent/carer. When both the parent/carer and infant are still, record the weight to the nearest 0.1kg (Figure 2). Subtract the parent/carers weight from this figure to obtain the childs weight. If the parent/carer is very heavy, e.g. more than 100kg, and the infant is relatively light, e.g. less than 2.5kg, the infants weight may not register on the scale. In such cases, ask a lighter person to hold the infant. Figure 1
Figure 2
Weighing an infant alone: for infants <2 years old who will lie still Place a thin piece of cloth or soft paper into a pan scale. Lie the unclothed infant on the cloth or paper and wait for him/her to stay still, to allow the scale to settle. Record the infants weight to the nearest 0.1kg. Weighing a child alone: for children 2 years old who will stand still The child should stand barefoot in the middle of the scale, with feet slightly apart, and remain still until his/her weight appears on the scale display (Figure 3). Record the childs weight to the nearest 0.1kg.
Figure 3
Preparing to measure an infant or child Remove the infant or childs shoes and socks. Remove any accessories from the infant or childs hair, e.g. clips and hairbands, and undo braids if they are likely to interfere with the length or height measurement. If infant is <2 years old, remove his/her nappy. Measuring length: for infants <2 years old or children who cannot stand Cover the length board with a thin cloth or soft paper (Figure 4). Ask the parent/carer to place the infant on the length board. The infant should be laid on his/her back with his/her head against the fixed headboard, compressing the hair (Figure 5). Make sure that the infants head does not move from side to side and is positioned with the infant looking up. Ask the parent/carer to keep the infants head in this position (Figure 5). Ensure that the infant lies straight, with his/her shoulders touching the board. The spine should not be arched. Hold the infants legs down with one hand and pull the footboard against the soles of his/her feet with the other (Figure 6). Record the infants length to the nearest 0.1cm. If the child is 2 years old, but cannot stand, measure length and subtract 0.7cm to convert it to height. Figure 6 Figure 5 Figure 4
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* Developed from UK-WHO growth charts. Growth charts may also be used to assign a score for step 3 of STAMP
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Weight centiles (kg) Age Birth 2 months 4 months 6 months 8 months 10 months 12 months 14 months 16 months 18 months 20 months 22 months 24 months 0.4th 2.17 3.95 5.15 5.9 6.45 6.85 7.2 7.5 7.85 8.1 8.4 8.7 9 2nd 2.5 4.3 5.5 6.35 6.9 7.3 7.7 8.1 8.4 8.7 9 9.4 9.7 9th 2.83 4.7 6 6.85 7.45 7.9 8.3 8.7 9.1 9.4 9.75 10.1 10.4 25th 3.16 5.12 6.5 7.4 8 8.5 8.95 9.37 9.75 10.1 10.5 10.9 11.3 50th 3.5 5.56 7 7.94 8.6 9.2 9.65 10.1 10.5 10.95 11.35 11.75 12.1 75th 3.84 6.05 7.55 8.55 9.26 9.8 10.4 10.9 11.4 11.8 12.3 12.7 13.1 91st 4.17 6.55 8.15 9.2 9.95 10.6 11.2 11.7 12.2 12.7 13.2 13.7 14.2 98th 4.5 7.2 8.75 9.85 10.65 11.45 11.95 12.6 13.2 13.7 14.15 14.7 15.3 99.6th 4.84 7.65 9.4 10.6 11.45 12.2 12.9 13.5 14.05 14.7 15.25 15.9 16.4
Height centiles (cm) Age Birth 2 months 4 months 6 months 8 months 10 months 12 months 14 months 16 months 18 months 20 months 22 months 24 months 0.4th 44.8 53.1 58.3 62 64.7 67.2 69.5 71.5 73.4 75 76.8 78.3 79 2nd 46.1 54.5 59.5 63 66 68.5 70.8 73 75 76.8 78.5 80 81 9th 47.9 55.8 61.1 64.8 67.6 70.2 72.5 74.8 76.8 78.6 80.5 82.1 83 25th 49.5 57.1 62.5 66.2 69.1 71.7 74.1 76.4 78.5 80.4 82.3 84.1 85.1 50th 51 58.4 63.9 67.6 70.6 73.3 75.8 78.1 80.2 82.2 84.2 86 87.1 75th 52.5 59.8 65.3 69.1 72.1 74.8 77.3 79.7 82 84.1 86.1 88 89.2 91st 54.1 61.1 66.7 70.5 73.5 76.4 78.9 81.4 83.6 85.8 87.9 89.9 91 98th 55.9 62.5 68 72 75 77.8 80.5 83 85.5 87.8 89.8 92 93.5 99.6th 57.1 63.7 69.4 73.3 76.5 79.3 82 84.6 87 89.5 91.6 93.8 95.3
Weight centiles (kg) Age Birth 2 months 4 months 6 months 8 months 10 months 12 months 14 months 16 months 18 months 20 months 22 months 24 months 0.4th 2.1 3.6 4.6 5.3 5.8 6.2 6.5 6.85 7.2 7.5 7.8 8.1 8.35 2nd 2.4 3.9 5 5.7 6.2 6.6 7 7.3 7.9 8 8.3 8.7 9 9th 2.7 4.3 5.45 6.2 6.75 7.2 7.6 8 8.35 8.7 9 9.4 9.75 25th 3.04 4.7 5.9 6.73 7.32 7.8 8.25 8.65 9 9.4 9.8 10.2 10.6 50th 3.36 5.12 6.45 7.3 7.95 8.47 8.95 9.4 9.8 10.2 10.65 11.1 11.5 75th 3.68 5.6 6.98 7.94 8.64 9.2 9.72 10.2 10.7 11.1 11.6 12 12.5 91st 4 6.1 7.6 8.6 9.4 10 10.6 11.1 11.6 12.1 12.6 13.1 13.6 98th 4.3 6.6 8.2 9.3 10.2 11 11.5 12.1 12.7 13.2 13.8 14.3 14.9 99.6th 4.6 7.2 8.9 10.1 11 11.8 12.5 13.2 13.8 14.4 15 15.6 16.2
Height centiles (cm) Age Birth 2 months 4 months 6 months 8 months 10 months 12 months 14 months 16 months 18 months 20 months 22 months 24 months 0.4th 44.7 51.6 56.3 59.7 62.5 65 67.1 69.3 71.3 73 74.8 76.3 77.2 2nd 46 53 57.5 61 64 66.5 69.5 71 73 75 76.5 78.3 78.9 9th 47.3 54.3 59.2 62.7 65.6 68.2 70.5 72.8 74.8 76.8 78.6 80.5 81.3 25th 48.6 55.7 60.6 64.2 67.1 69.8 72.3 74.6 76.7 78.7 80.7 82.5 83.5 50th 50 57 62.1 65.7 68.8 71.5 74 76.4 78.6 80.7 82.7 84.6 85.7 75th 51.3 58.5 63.5 67.3 70.3 73.2 75.7 78.2 80.5 82.7 84.7 86.7 87.9 91st 72.7 59.8 65 68.8 71.9 74.8 77.4 80 82.4 84.6 86.7 88.8 90 98th 54 61.1 66.5 70.3 73.5 76.4 79.2 81.7 84.2 87 88.7 91 92.5 99.6th 55.3 62.5 67.9 71.7 75 78 80.8 83.5 86 88.5 90.6 92.8 94.3
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* Developed from UK-WHO growth charts. Growth charts may also be used to assign a score for step 3 of STAMP.
For more information, and to download other materials, please visit www.stampscreeningtool.org