Standards der ernährungsmedizinischen Versorgung in der ambulanten und stationären Pädiatrie durch spezialisierte Einrichtungen der Kinder- und Jugendmedizin | Standards of nutritional medical care in outpatient and inpatient pediatrics by specialized facilities of pediatric and adolescent medicine: Statement by the Nutrition Committee of the German Society for Pediatric and Adolescent Medicine (DGKJ)

Healthy growth and development are based on an adequate supply of energy and nutrients and are a prerequisite for the maintenance of health and performance ability. In cases of illness, malnutrition impedes the recovery process and promotes the development of complications. The high prevalence of malnutrition is conspicuous, particularly in children below 2 years of age and those with chronic illnesses, e.g. Crohn’s disease, celiac disease, diabetes mellitus, asthma, allergies and epilepsy. A qualified dietary therapy can improve treatment success and therefore reduce disease-related complications. A preventive and therapeutic nutritional counseling requires significantly more time and personnel for children compared to adults. In childhood the treatment has to be individualized in the context and course of the underlying disease, including treatment of parents, family and other care providers over various age and developmental stages. The treatment of malnutrition in childhood and adolescence not only requires counseling as part of a multiprofessional holistic treatment with sustained follow-up, but also the elaboration and implementation of professional training concepts. In this statement standards for pediatric nutritional treatment and therapy are described for the outpatient and inpatient areas, which seem to be urgently necessary to achieve the individual treatment goals including the necessary resources. This also involves the interdisciplinary collaboration in a team consisting of a pediatrician, nutritional expert, pediatric nursing staff as well as psychologists and social workers where applicable; however, in order to achieve an appropriate time-consuming and personnel-intensive management of children and adolescents with malnutrition, remuneration by health insurers needs to be provided. Thus, it is necessary that the medical directive (Heilmittel-Richtlinie, HMR) as well as the diagnosis-related groups (DRG) are extended to all pediatric patients with nutrition-related diseases to enable cost-covering reimbursement of pediatric nutritional counseling and training not only in outpatient but also inpatient pediatric management.