Malnutrition in pediatics,community based approach
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This document discusses malnutrition, specifically protein-energy malnutrition. It defines malnutrition and describes the main types as kwashiorkor, marasmus, and marasmic kwashiorkor. The causes of malnutrition include social, economic, biological, and environmental factors. Clinical features depend on the type, severity, and duration of nutritional deficiencies. Assessment involves taking a history and conducting an examination. Management involves prevention, treatment of complications, dietary therapy starting with F100/F75 feeds, and nutritional/social rehabilitation with maternal involvement.
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Malnutrition in pediatics,community based approach
- 2. WHO defines Malnutrition as "the cellular imbalance between the supply of nutrients and energy and the bodys demand for them to ensure growth, maintenance, and specific functions.“ Malnutrition is the condition that develops when the body does not get the right amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function.
- 3. PROTEIN ENERGY MALNUTRITION It is a group of body depletion disorders which include: • kwashiorkor, • marasmus • marasmic kwashiorkor
- 4. MARASMUS • Represents simple starvation . The body adapts to a chronic state of insufficient caloric intake. KWASHIORKOR • is the body’s response to insufficient protein intake but usually sufficient calories for energy
- 5. AETIOLOGY: Social and Economic Factors: poor knowledge about weaning and f eeding,poverty,malpractices,inavailability of food,lack of birth spacing Biological factors (disease): acute: diarrhea,pneumonia,fever,worm infestation Chronic: heart diseases , asthma,malabsorption Environmental factors: improper sanitation and poor food hygiene Role of Free Radicals & Aflatoxin
- 7. Clinical features The clinical presentation depends upon the type, severity and duration of the dietary deficiencies. Thefive forms of PEM are : 1. Kwashiorkor 2. Marasmic-kwashiorkor 3. Marasmus 4. Nutritional dwarfing 5. Underweight child
- 8. Assessment History: • nutritional,developemntal,present or past acute or chronic illness,socioeconomic status,family history Examination: • anthropometry: height weight mid upper arm circumference, skin fold thickness qnd charting in growth chart • Signs of acute or chronic ilnesses: anemia,clubbing.jaundice,crepts in chest,abdomen tenderness
- 9. KWASHIORKOR
- 21. Management • Awareness of malnutrition as a problem • Assessment of nutritional status Anthropometry, Clinical examination, Dietary history, Socioeconomic history • Identify the type of malnutrition • Detect the associated deficiencies and complications • Decides on the treatment plan
- 22. Management plan Type Principle Method Place Mild Provision of adequate diet to fulfill the needed energy, protein and micronutrients Nutrition counseling (NC) including demonstration, supervised feeding and food supplementation if needed Home with support from mother’s group, SHP, Nutrition Rehab Center Moderate As above plus: identification and treatment of underlying infectious illness and MND NC as above plus feeding during illness Home with support from institutions in the vicinity Severe Resuscitation to prevent deaths from complications Dietary therapy Treatment of underlying diseases and MND Medical management of complications, treatment of infections and MND NRC or hospital in presence of complications or OTP in the absence of complications
- 24. 1.Prevention and treatment of life threatening complications Complications Action Hypoglycemia (Blood sugar < 50 mg/dl) Immediate feeding with 10% glucose, IV glucose if unconscious Frequent feeding Keep warm, start antibiotics Hypothermia Keep warm with blankets, heater, feed frequently, start antibiotics Dehydration Give ReSoMal fluid orally or by NG tube slowly Electrolyte imbalance Give extra potassium and magnesium Infection If without complications Cotrimoxazole, If with complications: Amoxicillin plus gentamicin, if fails to improve within 48 hrs; add Chloramphenicol Micronutrient deficiency Multivitamin Supplement plus zinc, copper; once starts gaining weight add iron, Vit A
- 25. Associated conditions Associated conditions Treatment Eye problems: xerophthalmia Vitamin A on days 1, 2 and 14 Chloramphenicol or tetracycline eye dropsX4 times daily for 7-10 days Instil atropine eye drops 1 dropX3 tid for 3-5 days Cover with saline soaked eye pads Bandage the eyes Severe anemia Whole or packed cell blood transfusion if Hb < 4 gms or 4-6 gms/dl with respiratory distress, slowly, monitor frequently for overload, give furosemide Skin lesions Soak the area in KMnO4 Sol, apply zinc and casto oil ointment Continuing diarrhea Metronidazole Lactose replacement, use lower osmolar feeding formula Tuberculosis Mantoux test, CXR: if positive treat according to NTP
- 26. 2. Dietary management • Start with feeds: F100 F75 These have fixed amount of callories and proteins
- 27. 3. Nutritional and social rehabilitation • Sensory stimulation: Provide tender loving care, play therapy for 15-30 minutes a day, physical activity as soon as the child is well enough • Maternal involvement in preparing the feeds, taking care of the child, keeping the child warm and in sensory stimulation • Provide suitable toys in the ward
- 29. • Thank you