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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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