This study aimed to determine prevalence and severity of malnutrition with respect to underlying diagnosis and co-morbid nutrition and feeding related problems in pediatric neurology outpatients. A total of 1,057 pediatric neurology outpatients (7.2±5.4 years, 56.9% males) were included. Data on patient demographics, neurological diagnosis, anthropometrics and Nutritional Questionnaire (NQ) for co-morbid feeding difficulties and nutritional problems were recorded. Epilepsy (45.2%) was the most common diagnosis, while prevalence of acute malnutrition was 17.7%. Nutritional support resulted in a significant decrease in the percentage of malnourished patients (from 17.1% to 6.7%, p˂0.001) and significant improvement in weight for height scores (increased to 81.42±8.17, p=0.045). In NQ-10 item assessment, at least one item was positive in 66.0% (gastrointestinal in 54.3%) of acutely malnourished patients, more commonly in severe acute malnutrition. NQ 4- item set of `red flags` revealed that prolonged meal time, meal time stressful to child or parent, lack of weight gain not just weight loss and cough during feeding were evident in 45.2%, 46.8%, 36.7% and 14.8% of patients with acute malnutrition, respectively; and more common in patients with severe malnutrition. NQ 4-item set of `red flags` was associated with high sensitivity (95%) and specificity (88%) in detection of malnutrition. In conclusion, our findings in a cohort of pediatric neurology outpatients revealed that 17.1% of overall patients were acutely malnourished along with higher prevalence of malnutrition in underlying diagnosis of cerebral palsy and higher likelihood of nutritional problems and feeding difficulties in severe malnutrition. Given the association of 6-month nutritional support with improved anthropometrics and decreased percentage of malnourished patients, our findings indicate that increased awareness of nutritional status and nutritional support is essential for the care of neurologically impaired children with potential benefit of identifying early feeding/swallowing related signs of malnutrition.

Keywords: anthropometrics, malnutrition, nutritional status, pediatric neurology, questionnaire