Malnutrition topic in paediatrics slide show

This is a presentation on malnutrition in children.

1. MALNUTRITION

2. DEFINITION Diet does not provide adequate calories and protein for growth and maintenance or they are unable to fully utilise the food they eat due to illness (undernutrition) They consume too many calories (over nutrition)

3. UNDERNUTRITION Underweight for one’s age Too short for one’s age (stunted) Low birth weight, inadequate supplementary feeding and repeated infectious diseases contribute to future stunting Dangerously thin (wasted) Deficient in vitamins and minerals (micronutrient malnutrition)

4. Primary vs Secondary Undernutrition Outcome of insufficient food and is defined as a dietary energy intake below the the minimum level required to maintain the balance between energy intake and expenditure Also referred to as protein energy malnutrition (PEM) Due to secondary causes (chronic diseases) that limit an adequate supply of nutrients to the body

5. CAUSES OF PRIMARY MALNUTRITION

6. ASSESSMENT OF NUTRITIONAL STATE Dietary, medical and medication history Growth and anthropometric measurements Weight for age Height or Length for age - marker of chronic malnutrition Head circumference (for < 5 years of age) Weight for length or height - reflects recent weight loss (wasting) Body mass index - for > 2 years old Mid upper arm circumference (MUAC) - used as a screening tool

7. MUAC MUAC < 11.5cm - Severe wasting (red colour on MUAC tape) MUAC 11.5 - 12.4cm - Moderate malnutrition MUAC 12.5 - 13.5 - Mild malnutrition MUAC >13.5 - Normal (green colour on MUAC tape)

8. PHYSICAL EXAMINATION Physical examination to assess nutrition has several limitations as some physical signs may be caused by more than one nutrient deficiency A thorough head to toe examination should be performed, check vitals (complicated SAM with overwhelming infection can present with hypothermia) Signs of dehydration may be unreliable in a malnourished child Look for signs of shock Cold clay hands with capillary refill time greater than 3 seconds Weak fast pulse A lethargic or unconscious child

9. SEVERE ACUTE MALNUTRITION One or more of: Weight for height z - score < -3 Presence of bilateral pitting edema (in the absence of other causes of edema) MUAC < 11.5cm

10. IMCI Danger Signs Lethargy Shock Refusing feeds or anorexia Weeping skin lesions Hypothermia Convulsions Hypoglycemia Jaundice Dehydration Respiratory Distress Bleeding Vomiting all feeds

11. PRINCIPLES OF TREATMENT Phase I (Stabilisation) Main objective is not to achieve weight gain but to stabilise the child and allow the return of normal homeostasis Give enough energy and protein to meet basic needs Treatment of life-threatening complications Gradually increase food during transition phase as correction of metabolic disturbances leads to a return of appetite Phase II (Rehabilitation/Catch up growth) High energy high protein diet Child is stimulated emotionally and physically and the mother is trained to continue care home

12. WHO TEN STEPS OF TREATMENT STEP 1 - Treat/prevent hypoglycemia (Blood glucose < 3mmol) Mild asymptomatic hypoglycaemia - 10% dextrose (10ml/kg) orally Symptomatic hypoglycemia - 10% dextrose (5ml/kg) IV STEP 2 - Treat/prevent hypothermia (Rectal or oral temp < 35.5 or axillary temp < 35 STEP 3 - Treat/prevent dehydration STEP 4 - Correct electrolyte imbalances STEP 5 - Treat infection STEP 6 - Correct micronutrient deficiencies STEP 7 - Start cautious feeding STEP 8 - Achieve catch up growth STEP 9 - Provide sensory stimulation and emotional support STEP 10 - Prepare for discharge and follow up after recovery