COMMON PEDIATRIC NUTRITIONAL DISORDERS 2015.ppt

8/18/2019 COMMON PEDIATRIC NUTRITIONAL DISORDERS 2015.ppt

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Wilfredo Santos, MD.Neonatology

Rebecca Abiog Castro, M.D.

Pediatric Gastroenterology & Nutrition

Faculty of Medicine & Surgery, S!

Prepared by:


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A pathological state resulting from a relative or

absolute deficiency or excess of one or more

essential nutrients.

This state being clinically manifested or detected

only by biochemical, anthropometric or

physiological tests.


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ndernutrition"

pathological state resulting from the consumptionof an inadequate quantity of food over anextended period of time

S#ecific Deficiency

absolute or relative lack of an individual nutrient

$%ernutrition"

consumption of an excessive quantity of food foran extended period of time

'balance"

disproportionate intake among essential nutrients


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Diagnostic Criteria:

Anthropometric easurements:

!eight for age: Underweight"ength#$eight for age: Stunted

$ead circumference %until & years of age only'

!eight for length#height: Wasted

(ody mass index %()': Overweight/Obese

WHO Standard Deviation Growth Curve


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Z ScoreGrowth Indicators

Lt/Ht or a!e Wt or a!e Wt or Lt or Ht "#I or a!e

Above 3 (See Note 1)

(See Note 2)

Obese Obese

Above 2 Normal Overwei!ht Overwei!ht

Above 1 Normal Possib$e ris% o

overwei!ht(See Note 3)

Possib$e ris% ooverwei!ht(See Note 3)

0 (median) Normal Normal Normal Normal

Below - 1 Normal Normal Normal Normal

Below - 2Stunted(See Note 4)

Underweight Wated Wated

Below - 3Severel! tunted

(See Note 4)Severel! underweight

(See Note ")Severel! wated Severel! wated

*. A child in this range is very tall. This is rarely a problem unless the child is +excessivelytall, in -hich case, he should be referred for possible endocrine -orkup especially if bothhis parents are not tall.

/. A child in this range may have a problem but this is better assessed -ith -t for "t#$t or ()for age.

&. A plotted point above * sho-s possible risk. A trend to-ard the / 0score sho-s definite risk.

1. )t is possible for a stunted or severely stunted child to become over-eight.

2. This is referred to as very lo- -eight in )C) training modules.


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Maras'us %)nfantile atrophy, 3balanced starvation,

3old man face4': Due to severe deprivation of protein, energy, vitamins 5 minerals

Maras'ic()*as+ioror" $ave clinical findings of both marasmus 5 k-ashiorkor $ave edema, gross -asting and stunting

)*as+ioror %3sugar baby4': Due to a diet of a decreased protein but increased carbohydrate

intake -ith#-ithout superimposed infection


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Maras'us )*as+ioror

sual Age -( years /(0 years

1de'a None lo*er legs, face or

generali2ed

Wasting Gross loss so'eti'es +idden

of Sub3 fat

Muscle Wasting ob%ious so'eti'es +idden

Gro*t+ retardation ob%ious so'eti'es +idden

Mental C+anges a#at+etic, 4uiet irritable, alsoa#at+etic


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Maras'us )*as+ioror

Appetite good poor

Diarrhea often often

6kin Changes seldom flakypaint

dermatoses

$air Changes seldom sparse,

dyspigmentation

oon face seldom often

$epatic seldom al-ays

enlargement


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Maras'us )*as+ioror

6erum albumin 7 or lo- lo-

8rea#creatinine 7 or lo- lo-$ydroxyproline lo- lo-

9ssential AA normal lo-

Anemia uncommon common

"iver biopsy normal or fatty change atrophic


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A generali0ed excessive accumulation of fattysubcutaneous tissue

ay be due to overeating, genetic constitution,psychic disturbances, insufficient exercise,endocrine and metabolic disturbances


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Z ScoreGrowth Indicators

Lt/Ht or a!e Wt or a!e Wt or Lt or Ht "#I or a!e

Above 3 (See Note 1)

(See Note 2)

Obese Obese

Above 2 Normal Overwei!ht Overwei!ht

Above 1 Normal Possib$e ris% o

overwei!ht(See Note 3)

Possib$e ris% ooverwei!ht(See Note 3)

0 (median) Normal Normal Normal Normal Below - 1 Normal Normal Normal Normal

Below - 2Stunted(See Note 4)

Underweight Wated Wated

Below - 3Severel! tunted

(See Note 4)Severel! underweight

(See Note ")Severel! wated Severel! wated

*. A child in this range is very tall. This is rarely a problem unless the child is +excessivelytall, in -hich case, he should be referred for possible endocrine -orkup especially if bothhis parents are not tall.

/. A child in this range may have a problem but this is better assessed -ith -t for "t#$t or ()for age.

&. A plotted point above * sho-s possible risk. A trend to-ard the / 0score sho-s definite risk.

1. )t is possible for a stunted or severely stunted child to become over-eight.

2. This is referred to as very lo- -eight in )C) training modules.


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!+ree 'ost co''on nutrients, of #ublic +ealt+concern, t+at afflicts Fili#ino c+ildren"

5ita'in A Deficiency 65AD7

Ane'ia 6ron Deficiency Ane'ia 8DA97

Goiter 6odine Deficiency Disoder 8DD97


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Carotenoids, the precursors of it. A is ;


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Ma:or nutritional concern in #oor societies,es#ecially in de%elo#ing countries

Assessed by 'easuring t+e #re%alence of deficiencyin a #o#ulation, re#resented by"

s#ecific bioc+e'ical 'arers 6lo* seru' retinol7

clinical indicators of status 6;ero#+t+al'ia7


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G$oba$ preva$ence o vita&in ' deiciency in popu$ations at ris% ())*+,--*

WHO Global Database on Vitamin A Deficiency


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5ision

1#it+elial differentiation

Gro*t+

Re#roduction Pattern for'ation during e'bryogenesis

one de%elo#'ent

e'ato#oiesis

rain de%elo#'ent ''une syste' function


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7yctalopia or night blindness >hotophobia ?erosis con@unctivae

(itot4s spot Corneal xerosis ?eropthalmia 6kin signs: branny desquamation, follicular

hyperkeratois, defective teeth enamel


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Clinical 'anifestations"Nig+t blindness

Eero#t+al'ia 6itots s#ot, erato'alacia7

Dar ada#tation tests assess early(stage %ita'in A

deficiency

5ita'in A le%els 6N5"-- gHdI7


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Bitot #ot $ero#hthalmia


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N$ sign of %ita'in A deficiency" Prophylaxis ?-,--- single dose 6J 'ont+7 /--,--- single dose 6(/ 'ont+7 --,--- single dose 6K/ 'ont+7

Gi%en e%ery 'ont+s until ris factor disa##ears

Sign of %ita'in A deficiency Treatment: J 'ont+s" /?-,--- (/ 'ont+s" /--,--- K / 'ont+s" --,---

Gi%en on day /, day and *ees fro' first dose


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%he #revalen&e o' anemia among month to 1 !earha remained unabated in&e 1**3+ and in&reaed 'rom

4*,2 to an alarming rate o' ,

Anemia among 1-" !.o remained at 2*,1,


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/. ron de#letionStorage iron is absent or decreased

Nor'al seru' iron conc and gb le%els

. ron deficiency *it+out ane'ia

Decreased or absent iron storage

Io* seru' iron concentration

Io* transferrin

No fran ane'ia0. ron deficiency ane'ia

Io* gbHct %alue


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A significant body of causal e%idence e;ists for"

*. )rondeficiency anemia and -ork productivity

/. 6evere anemia and child mortality

&. 6evere anemia and maternal mortality

1. )rondeficiency anemia and child development


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!issue effects of DA"

*. B)T: anorexia, pica, atrophic glossitis, leakygutsyndrome %exudative enteropathy'

/. C76: irritability, conduct disorder, cognitive↓function

&. C6: $ 5 C, cardiac hypertrophy, plasma↑ ↑volume


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egular response to adequate amounts of iron is animportant diagnostic and therapeutic feature.

ral administration of simple ferrous salts %e.g.,sulfate, gluconate, fumarate' provides inexpensiveand satisfactory therapy.


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Therapeutic dose

1E; mg#kg of elemental iron in & divided doses

Ferrous sulfate /


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Therapeutic dose

1E; mg#kg of elemental iron in & divideddoses

Ferrous sulfate /


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*. 8npleasant taste can be camouflaged by mixing -ithflavored syrup

/. lder children and adolescents sometimes have B)complaints

Constipation can be minimi0ed by -ater 5↑

fiber intake

Abdominal discomfort can be minimi0ed byadministering iron -ith food, but may

decrease iron absorption to some extent.


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nade4uate intae or 'etabolis' of iodine. t directlyaffects t+yroid secretions, *+ic+ influence +eartaction, ner%e res#onse, gro*t+ rate, and 'etabolis'

Si'#le goitre, t+e 'ost fre4uent result, is 'ost co''on inareas *it+out access to salt *ater and is rare along seacoasts.

Se%ere, #rolonged deficiency can cause +y#ot+yroidis'.

1ating seafood regularly or using iodi2ed table salt *ill#re%ent iodine deficiency. So'e countries +a%e 'ade dietaryiodine additi%es 'andatory.

http://www.britannica.com.ph/chemistry/iodine-368131.htmlhttp://www.britannica.com.ph/medicine/thyroid-gland-380708.htmlhttp://www.britannica.com.ph/medicine/goitre-365772.htmlhttp://www.britannica.com.ph/medicine/goitre-365772.htmlhttp://www.britannica.com.ph/medicine/thyroid-gland-380708.htmlhttp://www.britannica.com.ph/chemistry/iodine-368131.html


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A fe* salient facts

)odine deficiency is one of the main cause of impaired

cognitive development in children.

The number of countries -here iodine deficiency is apublic health problem has halved over the past The

number of countries -here iodine deficiency is apublic health problem has halved over the past decadeaccording to a ne- global report on iodine status.


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21 countries are still iodinedeficient.

9fforts are required to strengthen sustainable salt

iodi0ation programmes.

)odine deficiency is the -orld4s most prevalent, yeteasily preventable, cause of brain damage. Today -e

are on the verge of eliminating it E an achievementthat -ill be hailed as a ma@or public health triumphthat ranks -ith getting rid of smallpox andpoliomyelitis


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+nearly / billion individuals had insufficientiodine intake, a third being of school age. ...

Thus iodine deficiency, as the single greatestpreventable cause of mental retardation, is animportant publichealth problem.4

The Lancet !$, in /


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"o- dietary iodine 6elenium deficiency >regnancy 9xposure to radiation )ncreased intake#plasma levels of goitrogens, such as calcium Bender %higher occurrence in -omen' 6moking tobacco Alcohol %reduced prevalence in users' ral contraceptives %reduced prevalence in users' >erchlorates Thiocyanates


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6igns and symptoms

>resence of possible risk factors

/1hour urine iodine collection %approximatelyL


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Food supplements fortified -ith iodine

ild cases may be treated by using iodi0ed

salt in daily food consumption, or eatingmore of milk, egg yolks, and salt-ater fish

)n an adult, *2< Mg#d is sufficient for normal

thyroid function.J/


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)odine supplementation results -ith shrinkage ofgoiters caused by iodine deficiency in very youngchildren and pregnant -omen


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>reventive easures:8se of iodi0ed salts:

Addition of small amounts of iodine to table salt in formof sodium iodide, potassium iodide, and#or potassium

iodate,

Food fortification such as flour, -ater and milk inareas of deficiency.

)ntake of seafood, a good source thus, iodinedeficiency is more common in mountainous regions-here food is gro-n in soil poor in iodine.


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(eriberi

Types: Dry (eriberi E the infant may appear -ell

nourished but pale, listless, flabby, cyanotic anddyspneic, tachycardic -ith enlarged liver

!et (eriberi the infant is edematous, pale,

undernourished, dyspneic -ith vomiting andtachycardia


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ther types:

*. Acute cardiac type E occurs at age /1months. !ith cyanosis, dyspnea, systolic

murmur, pulmonary edema/. Aphonic type E develops at age 2H months

-ith hoarseness, dysphonia or aphonia

&. >seudomeningeal type E develop at N*<

months -ith apathy, dro-siness and signs ofmeningeal irritation


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Diagnosis: therapeutic test of parenteralthiamine results in dramatic symptom andsign improvement

>revention: thiamine at


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8sually occurs -ith other deficiencies ofitamin ( complex

Angular stomatitis, cheilosis, glossitis,

fissuring of the tongue

6crotal or vulval dermatosis, nasolabialseborrhea

>hotophobia, blurred vision cornealvasculari0ation


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Diagnosis: 8rinary riboflavin determination and(C riboflavin load test

>revention: O *< years old


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Cause"

A deficiency disease caused by diets lo- in niacinand#or tryptophan

Clinical 'anifestations"Triad of diarrhea, dermatitis and dementiaG also

depression, irritability, insomnia and delirium

Diagnosis" signs and symptoms

Pre%ention:;*< mg for infants and less than *< years old. lder is

*


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Cause"Deficiency occurs due to losses of pyridoxine from

refining, processing, cooking and storing of food

Clinical Manifestations:Convulsion, depression, seborrheic dermatitis,

intertrigo, angular stomatitis, glossitis, poor response toinfection

Diagnosis"

tryptophan load testG response of sei0ure to (;treatment

!reat'ent: ) pyridoxine in@ection /*< mg or *


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6curvy

Due to it C deficient diet

6#6x: >seudoparalysis, spongy gum bleeding, rosary

of scorbutic beads at the costochondral @unctions,petechiae, orbital or subdural hemorrhages

Diagnosis: ?ray of the long bones: atrophy of the

boneG it C blood levels

Treatment: /


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Deficiency of it Q dependent factors%prothrombin, factors )), )?, ?', exclusivelybreastfed infants, antibiotic adminstration

6#6x: (leeding from cord, B) bleeding, intracranialbleeding, anemia, hematuria

>revention and Treatment: it Q administration at

birth. Transfusion of deficient factors


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"ack of vitamin D in the diet and lack of access ofthe skin from ultraviolet irradiation

6#6x: rachitic rosary, craniotabes, gro-th

impairment, mental retardation, bo-ing of legs,knockknees

Diagnosis: ?ray of the involved bones

Treatment: 1


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Del undo, et.al Textbook of >ediatrics andChild $ealth, 1th edition

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COMMON PEDIATRIC NUTRITIONAL DISORDERS 2015.ppt

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