Nutritional Disorders Telehealth Network Project

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Screening Tools

Instructions for Screening and Scoring

Initial Screening

The initial screener is used to assess, 1) if the caregiver perceives the child to have an issue with their weight and nutrition, and 2) is the child at risk for a nutritional disorder based on their height and weight measurements. 

Caregivers will be asked to complete the initial screener and return it to the provider upon completion.  The provider will then take accurate height and weight measurements, and plot those measurements on the appropriate growth chart.  If the child is below the 5th percentile or above the 85th percentile, the Undernutrition Secondary Screener and the Overnutrition Secondary Screener should be distributed to the caregivers to complete. 

If the caregiver endorses that they believe their child has an issue with their weight but falls into a healthy range, the provider may consider having a discussion with the caregiver about developmentally healthy weights. 

Secondary Screening

The secondary screeners are used to assess the etiology of the nutritional disorder and determine areas of concern in order to determine what interventions may be necessary.  Each question on the screener was designed to identify the different etiological constructs that may be contributing to the nutritional disorder. 

Caregivers are asked to complete the front-page of the secondary screener and return it to the provider for scoring. 

On the scoring chart for the secondary screener, each column corresponds to an etiological construct and each question on the screener corresponds to a row on the scoring chart.  Within each row, the different etiological constructs pertaining to that question are identified.  If a caregiver responds to the question in such a way that is not accordance with appropriate nutritional or behavioral practices (i.e. child does not eat vegetables, meals are eaten in front of the television), each box within that row receives a tally.  Once all the questions have been scored, the tallies in each column are added up and total scores are recorded in the appropriate box.  Clinical cut-offs have been provided, and if the total score of that column exceeds the clinical cut-off, this etiological construct should be identified as an area for intervention. 

Screening Tools

Initial Screener (.pdf)
Initial Screener - Spanish (.pdf)

Undernutrition Secondary Screener (.pdf)
Undernutrition Secondary Screener - Spanish (.pdf)

Overnutrition Secondary Screener (.pdf)
Overnutrition Secondary Screener - Spanish (.pdf)

Screening Reports

Overnutrition Screening Report (.pdf)
Undernutrition Screening Report (.pdf)
© 2015 Medical College of Wisconsin
Page Updated 04/15/2014