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MALNUTRITION IN CHILDRENDR. MAILYN C. GONZALEZ

PDR III- PEDIATRICS LECTURE

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MALNUTRITION

Pathological state resulting from a relative orabsolute deficiency or excess of one or moreessential nutrients

2 ends of the spectrum:

OBESITY

UNDERNUTRITION

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MALNUTRITION

It is the biggest single contributor to childmortality particularly in the 1 to 3 year age groupin the developing countries

Philippines:

Mortality rate in 1-4 years old per 1000 children is 7.6,

compared to 1 in the US

Study by the Food and Nutrition Research Center:highest incidence of malnutrition is in the toddler

age group (1-5 years old).

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ASSESSMENT:

WATERLOWE CLASSIFICATION

deficits in weight for height (WASTING)

Acute malnutrition

deficits in height for age (STUNTING)

Chronic malnutrition

Implies a process that has continued for a long time

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STUNTING

Actual height/length (cm)

Ideal Height for Age (cm)

Normal……….. =/>95% 

Mild……………90-95%

Moderate……80-90%

Severe………..

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WASTING

Actual Weight (kg)

Ideal weight for actual height/length (kg)

Normal…………..=/>90% 

Mild………………80-90%

Moderate………70-80%

Severe…………..

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Compute: 2yo/male, came in for 5 days watery stool and

vomiting

Actual Weight: 11kg

Weight for height: 13kg

Actual length: 85 cm

Length for age: 87cm

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STUNTINGActual height: 85cm

Height for age: 87cm

= 0.97x100

= 97%

NORMAL

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WASTINGActual weight: 11kg

Ideal weight for actual height/length:13kg

=0.84x100

= 84%

MILD WASTING

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PROTEIN ENERGY

MALNUTRITION The term protein energy malnutrition has been

adopted by WHO in 1976

Highly prevalent in developing countries among

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SEVERE CHILDHOOD PEM KWASHIORKOR: disease when child is displaced

from breast

MARASMUS: extreme wasting

MARASMIC- KWASHIORKOR: differentmanifestations of similar nutritional deficits ofenergy, protein, micronutrients

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PROTEIN ENERGY

MALNUTRITION

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KWASHIORKOR Maximal incidence is in the 2nd year of life

following abrupt weaning

Dietary factors

Contributing factors- infection, psycho-social,and cultural

Theory says

It is a result of liver insult with hypoproteinemia andedema

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KWASHIORKOR

CONSTANT FEATURES Edema: cardinal sign 

Mental changes

Growth retardation

Wasting

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KWASHIORKOR

USUALLY PRESENT SIGNS Moon face

Hair changes: flag sign

Skin depigmentation

Anemia: due to iron and folic deficiencies

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KWASHIORKOR

OCCASIONALLY PRESENT SIGNS

Hepatomegaly

Flaky paint dermatosis

Cardiomyopathy and failure

Dehydration (diarrhea and vomiting)

Signs of vitamin deficiencies

Signs of infections

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PROTEIN ENERGY

MALNUTRITION

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MARASMUS Caused by inadequate intake of protein and

calories and is characterized by emaciation

An adaptive response to starvation; whereaskwashiorkor represents a maladaptive responseto starvation

The body utilizes all fat store before using muscles

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MARASMUS Seen most commonly in the first year of life due

to lack of breast feeding and the use of dilutemilk

Poverty and diarrhea are the usual precipitatingfactors

Ignorance and maternal nutrition arecontributory

Too little breast milk or complementary foods in

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MARASMUS

CLINICAL FEATURES Severely wasted (emaciated) and stunted

 “balanced starvation” 

 “old man” facie, wrinkled appearance, sparse

hair

No edema, fatty liver, or skin changes

Alert but miserable

Hungry

Diarrhea and dehydration

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DIAGNOSTIC EVALUATION History- including detailed dietary history

Physical exam

Anthropometric measurements

Height and weight

Head/ chest circumference

Mid upper arm circumference

Laboratory tests

Full blood counts

Blood glucose profile/ electrolyes Septic screening

Stool and urine for parasites

Mantoux test

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COMPLICATIONS OF PEM Hypoglycemia

Hypothermia

Hypokalemia

Hyponatremia

Heart failure

 Dehydration and shock

Infections

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MANAGEMENT OF PEM S- Correction of Sugar deficiency

H- Prevention of Hypothermia

I- Treatment of Infections

EL- Correction of Electrolyte Imbalance

De- Correction of Dehydration

D- Treat Deficiency conditions (e.g. anemia)

OTHER

Dietary support:3-4g protein and 200 Cal/kg body wt+ vitamins and minerals

Counsel parents and plan future care includingimmunization and diet supplements

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