Paediatric Malnutrition: The Dietitian’s Role in Negligence Cases

Paediatric malnutrition happens in the UK

Malnutrition isn’t confined to low-income countries.

It happens here in the UK, too — especially in hospitals, care homes, and vulnerable children with chronic conditions.

As a paediatric dietitian and expert witness, I’ve seen malnutrition overlooked in both clinical practice and legal cases.

Early recognition and management are essential. When care falls short, the consequences can be devastating — and sometimes legally actionable.

Paediatric malnutrition is more common in the UK than is given notice

What Is Paediatric Malnutrition?

Definition: Inadequate intake or absorption of nutrients to meet growth needs. Malnutrition is a diagnosis as opposed to 'failure to thrive' (modern term is faltering growth) which is a clinical sign.

Types:

• Acute (wasting, weight loss)

• Chronic (stunting, faltering growth)

• Micronutrient deficiencies (iron, vitamin D, zinc)

  
  

Risk groups: Children with IBD, cancer, congenital heart disease, neurological conditions, or poor feeding skills.

Causes of Paediatric Malnutrition

• Inadequate feeding support (delayed tube feeding, poor weaning advice)

• Chronic illness increasing energy needs

• Feeding disorders (ARFID, swallowing difficulties)

• Food insecurity or neglect

Clinical Guidelines

• NICE NG75: All children should be screened for faltering growth and malnutrition.

• WHO growth standards used alongside centile charts.

• ESPEN/ESPGHAN guidelines emphasise dietitian involvement in multidisciplinary teams.

Legal relevance: Failure to follow these standards may be a breach of duty.

Case Example

A child with cerebral palsy was admitted multiple times with poor weight gain but never referred to a dietitian. By the time nutrition support was initiated, she had severe malnutrition requiring prolonged hospitalisation. In court, the delay in referral was considered a breach of care.

Role of the Dietitian in Legal Cases

• Reviewing growth charts, feeding records, diet history.

• Identifying breaches in care standards.

• Assessing causation: Did malnutrition directly cause harm?

• Providing CPR Part 35 reports for the court.

FAQs

Is paediatric malnutrition always preventable? Not always — but timely intervention can reduce severity.

What’s the difference between malnutrition and faltering growth? Faltering growth is a descriptive term and a clinical sign; malnutrition is a clinical diagnosis.

Why is this relevant to law? Because missed recognition or delayed treatment can have lifelong impacts, forming the basis of negligence claims.

Closing Thought

Paediatric malnutrition is both a medical and legal issue. For children, timely intervention means healthier futures. For courts, robust dietetic evidence helps ensure accountability where care standards fail.