In the February issue of ADC, Joosten and colleagues have shown that nearly one in five children in The Netherlands are malnourished on admission to hospital, and they have reiterated a call for routine screening and treatment of malnutrition in all hospitals.1 In this unique nationwide study, Joosten and his team were able to enlist 44 hospitals in collecting data on 424 children. The response of the Dutch government to these findings has been to oblige their hospitals to screen all children for malnutrition on admission. A further effect of this study will be to reopen the debate about routine nutritional screening in hospitalised children elsewhere in Europe.

The high prevalence of malnutrition in hospitalised children in The Netherlands is, in fact, similar to that reported in other European countries, USA, Brazil and Turkey. Nearly 20 years ago, Moy et al reported that 14% of 273 children in Birmingham Children's Hospital, UK were severely wasted, with a further 20% being considered to be ‘at risk’ of severe nutritional depletion.2 Similarly, last year, Pawelleck and colleagues found that 24.1% of 475 consecutive admissions to Dr von Hauner Children's Hospital in Munich, Germany were malnourished according to the Waterlow criteria.3 Not much has changed apparently in the last two decades.

Although comparisons between these studies are somewhat confounded by slightly different definitions of ‘malnutrition,’ the accumulation of published data does indicate the existence of what Moy et al called an ‘unrecognised reservoir of malnutrition …