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MALNUTRITION IN CHILDREN

DR. MAILYN C. GONZALEZ


PDR III- PEDIATRICS LECTURE

MALNUTRITION
Pathological state resulting from a relative or
absolute deficiency or excess of one or more
essential nutrients
2 ends of the spectrum:
OBESITY
UNDERNUTRITION

MALNUTRITION
It is the biggest single contributor to child
mortality particularly in the 1 to 3 year age group
in 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).

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

STUNTING
Actual height/length (cm)
Ideal Height for Age (cm)

Normal.. =/>95%

Mild90-95%
Moderate80-90%
Severe..<80%

WASTING
Actual Weight (kg)
Ideal weight for actual height/length (kg)

Normal..=/>90%

Mild80-90%
Moderate70-80%
Severe..<70%

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

STUNTING
Actual height: 85cm
Height for age: 87cm
= 0.97x100
= 97%

NORMAL

WASTING
Actual weight: 11kg
Ideal weight for actual height/length:13kg
=0.84x100
= 84%

MILD WASTING

PROTEIN ENERGY
MALNUTRITION
The term protein energy malnutrition has been
adopted by WHO in 1976
Highly prevalent in developing countries among
<5 children

All children with PEM have micronutrient


deficiency

SEVERE CHILDHOOD PEM


KWASHIORKOR: disease when child is displaced
from breast

MARASMUS: extreme wasting


MARASMIC- KWASHIORKOR: different
manifestations of similar nutritional deficits of
energy, protein, micronutrients

PROTEIN ENERGY
MALNUTRITION

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 and
edema

KWASHIORKOR
CONSTANT FEATURES
Edema: cardinal sign
Mental changes
Growth retardation
Wasting

KWASHIORKOR
USUALLY PRESENT SIGNS
Moon face
Hair changes: flag sign
Skin depigmentation
Anemia: due to iron and folic deficiencies

KWASHIORKOR
OCCASIONALLY PRESENT SIGNS
Hepatomegaly
Flaky paint dermatosis
Cardiomyopathy and failure
Dehydration (diarrhea and vomiting)

Signs of vitamin deficiencies


Signs of infections

PROTEIN ENERGY
MALNUTRITION

MARASMUS
Caused by inadequate intake of protein and
calories and is characterized by emaciation

An adaptive response to starvation; whereas


kwashiorkor represents a maladaptive response
to starvation
The body utilizes all fat store before using muscles

MARASMUS
Seen most commonly in the first year of life due
to lack of breast feeding and the use of dilute
milk
Poverty and diarrhea are the usual precipitating
factors
Ignorance and maternal nutrition are
contributory
Too little breast milk or complementary foods in
<2years of age

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

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

COMPLICATIONS OF PEM
Hypoglycemia
Hypothermia
Hypokalemia
Hyponatremia

Heart failure
Dehydration and shock
Infections

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 including
immunization and diet supplements

THANK YOU

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