a b l e

o is t
s tables ions or
iag n ce uct
d d ren str
an k re
f e
ring
i n
form q u ic e asu
l e m
n i n g c e nt i
g and
r e e h th
e
g hi n
Sc used d the w w i t e i
e n
To b arts, a
t h ch
grow

For more information, and to download other materials,

please visit www.stampscreeningtool.org

Supported by an Central Manchester University Hospitals

educational grant from

Date of preparation: April 2010 RXNPD100216

STAMP screening form
This form can be used to screen a child up to three times – please date, sign and initial
the space at the bottom of this sheet every time you do so.

Step 1 – Diagnosis
Does the child have a diagnosis that has
Score 1st screening 2 nd screening 3rd screening
any nutritional implications?
Definite nutritional implications 3
Possible nutritional implications 2
No nutritional implications 0
Step 2 – Nutritional intake
What is the child’s nutritional intake? Score 1st screening 2 nd screening 3rd screening
No nutritional intake 3
Recently decreased or poor
2
nutritional intake
No change in eating patterns and good
0
nutritional intake
Step 3 – Weight and height
Use a growth chart or the centile quick 1st screening 2 nd screening 3rd screening
reference tables to determine the Score wt: wt: wt:
child’s measurements ht: ht: ht:
> 3 centile spaces/≥ 3 columns apart (or
3
weight < 2nd centile)
> 2 centile spaces/= 2 columns apart 1
0 to 1 centile spaces/columns apart 0
Step 4 – Overall risk of malnutrition
Add up the scores from the boxes in
steps 1–3 to calculate the overall risk Score 1st screening 2 nd screening 3rd screening
of malnutrition
High risk ≥4
Medium risk 2–3
Low risk 0–1
Step 5 – Care plan
What is the child’s overall risk of Use management guidelines and/or local nutrition policies to develop
malnutrition, as calculated in step 4? a care plan for the child
• Take action
High risk • Refer the child to a Dietitian, nutritional support team, or consultant
• Monitor as per care plan
• Monitor the child’s nutritional intake for 3 days
Medium risk • Repeat the STAMP screening after 3 days
• Amend care plan as required
• Continue routine clinical care
Low risk • Repeat the STAMP screening weekly while the child is an in-patient
• Amend care plan as required

Please complete
after each screening
Date Signature Initials Child’s name:

1st screening
2nd screening DOB:

3rd screening Hospital no.:

Supported by an Central Manchester University Hospitals

educational grant from

© 2010 Central Manchester University Hospitals NHS Foundation Trust

Diagnosis table
To be used to assign a score
for step 1 of STAMP

Definite nutritional implications Possible nutritional No nutritional

implications implications

Bowel failure, intractable diarrhoea Behavioural eating problems Day case surgery
Burns and major trauma Cardiology Investigations
Crohn’s disease Cerebral palsy
Cystic fibrosis Cleft lip and palate
Dysphagia Coeliac disease
Liver disease Diabetes
Major surgery Gastro-oesophageal reflux
Multiple food allergies/intolerances Minor surgery
Oncology on active treatment Neuromuscular conditions
Renal disease/failure Psychiatric disorders
Inborn errors of metabolism Respiratory syncytial virus ( RSV )
Single food allergy/intolerance

W
 hile 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

STAMP should be used in association with Trust referral guidelines and policies

Supported by an Central Manchester University Hospitals

educational grant from

© 2010 Central Manchester University Hospitals NHS Foundation Trust