MALNUTRITION IN CHILDREN Prepared By

Lamiaa 400@yahoo.com Pediatric Nursing

MALNUTRITION IN CHILDREN OBJECTIVES

To understand meaning of Malnutrition To understand the etiology of Malnutrition. To list the Causes KWO and Marsmus in

children. Diagnose Malnutrition To identify the treatment and prevention for

KWO and marasmus.

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HUMAN NUTRITIONNutrients are substances that are crucial for human life, growth & well-being.

•Macronutrients (carbohydrates, lipids, proteins & water)•Micronutrients are trace elements & vitamins, which are essential for metabolic processes.

MALNUTRITIONMALNUTRITION

improper and / or inadequate food intake

inadequate absorption of food

Deficient supply of food

poor dietary habitsfood faddism

emotional factors metabolic abnormalities

diseases

WHO IS AFFECTED BY MALNUTRITION?

Infants, children, the elderly, prisoners) Mentally disabled or ill because they are

not aware of what to eat. People who are suffering from tuberculosis, eating disorders, HIV/AIDS, cancer, or who have undergone surgical procedures

are susceptible to interferences with appetite or food uptake which can lead to malnutrition.

MALNUTRITION Malnutrition: Is defined as pathological state

resulting from relative or absolute deficiency of one or more essential nutrients( Malnutrition…..Kwashiorkor)

Kwashiorkor :is a form of malnutrition caused by inadequate Protein intake in the presence of fair to good energy (total calories) intake.

Malnutrition is common in children between age of above one year 2 years

Under nutrition It is the outcome of insufficient food. It is caused primarily by an inadequate intake of dietary or food energy.

Under nutrition…….Marasmus

DEFINITIONS OF MALNUTRITION

Kwashiorkor: protein deficiency Marasmus: energy deficiency Marasmic/ Kwashiorkor: combination of

chronic energy deficiency and chronic or acute protein deficiency

PROTEIN MALNUTRITIONPROTEIN MALNUTRITION

))PCM or PEM, Protein-Calorie (Energy) MalnutritionPCM or PEM, Protein-Calorie (Energy) Malnutrition , ,

KwashiorkorKwashiorkor((

Clinical syndrome resulted from a severe deficiency of protein & inadequate caloric intake

KWASHIORKORKWASHIORKOR

FACTORS THAT EFFECT PROTEIN NEED

1) Age -- child needs more protein 2) Size -- bigger person needs more

protein.3) Sex -- male needs more than

female.4) Danger -- increases need due to

stress hormones5) Exercise -- increases need for

alanine6) Fever -- increases need7) Growth -- increases need

Deficient intake of protein Impaired absorption of protein, as in

chronic diarrheal states Abnormal losses of protein in proteinuria Infection(TB) Hemorrhage or burns Failure of protein synthesis, as in chronic

liver diseases

ETIOLOGYETIOLOGY

DIAGNOSIS OF KWO

The physical examination may show an enlarged liver (hepatomegaly) and general swelling.

Tests may include: Arterial Blood Gas. Complete Blood Count CBC Creatinine Clearance. Serum Creatinine. Serum Potassium. Total Protein Level. Urinanalysis

CLINICAL MANIFESTATION

Constant or cardinal manifestation

Usual manifestation

CONSTANT OR CARDINAL MANIFESTATION

1-Growth Retardation Weight is diminished Retarded liner growth length HC may be affected Bone age may be retarded

2-Oedema Hypoprotenemia Start in lower part and become

generalized Usually soft and pitting edema The cheek become pale and waxy

CONSTANT OR CARDINAL MANIFESTATION3-Muscle Wasting Disturbed muscles fat ratio Generalized muscle waste determined

by mid arm circumference which is diminished

The children is weak hypotonic Unable to stand or walk4- PSYCHOMOTOR CHANGES Apathy Lack interest in surrounding Look sad and never smile His cry is weak(Moon Face)

USUALLY PRESENT SIGNS1-HAIR CHANGES sparse, hair lose its color become reddish or

grayish

2-Gastrointestinal manifestation

Anorexia-Vomiting- Diarrhea

3-SKIN DEPIGMENTATION (dermatosis-rash appear in the back of

thigh and axillary Hyopigmentation lead to skin damage

4-MOON FACE

5-Hepatomegalycaused

6-Poor resistance and liability to infection

KWASHIORKOR

COMPLICATIONS

1) DehydrationSkin infection

2) Hemorrhage3) Heart failure4) Chest infection5) Permanent mental and physical

disabilityCause of death KWO1. Recurrent infection2. Hypoglycemia 3. Heart failure

MANAGEMENT OF KWO Getting more calories and protein will correct

kwashiorkor. Treatment depends on the severity of the

condition. children who are in shock need immediate treatment to restore blood volume and maintain blood pressure.

Calories are given first in the form of carbohydrates, simple sugars, and fats.

Vitamins and mineral supplements are essential.

Food must be reintroduced slowly. Carbohydrates are given first to supply energy, followed by protein foods.

MARASMUS The term marasmus is derived from the

Greek marasmos, which means wasting or Starvation.

MARASMUSMARASMUS(Infantile Atrophy, energy-deficiency (Infantile Atrophy, energy-deficiency

or energy-protein deficiency)or energy-protein deficiency) -

LACK OF CALORIES

MARASMUS

Definition It is a clinical; syndrome resulting mainly under nutrition due to sever deficiency of protein,fat,and Carbohydrates inadequate calorie supply(starvation)

ETIOLOGY ETIOLOGY OF MARASMUSOF MARASMUS

Dietic causes Scanty milk Improper weaning and overdiluted formula Feeding difficulties as cleft lip Vomiting, diarrheas, Anorexia Stomatitis Malabsorption syndrome Cardiac abnormality Prematurity

CLINICAL FEATURES OF MARASMUScharacterized by: Sever wasting weight less than 60% Loss of subcutaneous fat Severe wasting of muscle & s/c fats Severe growth retardation Child looks older(old man) than his

age or senile face. No edema or hair changes Alert but miserable &Hungry Temperature is usually sub-normal

Emaciation Skin wrinkled Subcutaneous fat disappears from

abdomen first,Buttocks, then extremities, and finally face

MARASMUS

A thin “old man “face or Monkey Facies• “ Baggy pants “ (the loose skin of the

buttocks hanging down).

• There is no oedema (swelling that pits on pressure) of the lower extremities.

INVESTIGATIONS FOR PEM Full blood counts Blood glucose profile Septic screening Stool & urine for parasites & germs Electrolytes, Ca, Ph &, serum proteins CXR & Mantoux test

MANAGEMENT OF MARASMUS

Constant monitoring. Patients with marasmus should be isolated

from other patients, especially children with infections.

Treatment areas should be as warm as possible, and bathing should be avoided to limit hypothermia.

Therefore, the hospital structure is best adapted for the treatment of severe malnutrition.

MANAGEMENT OF MARASMUS

In cases of shock, intravenous (IV) rehydration is recommended using a Ringer-lactate solution with 5% dextrose or a mixture of 0.9% sodium chloride with 5% dextrose.

The following rules should be implemented in the initial phase of rehydration:

(1)Use an nasogastric (NG) tube; (2)Continue breastfeeding, except in case of

shock or coma; and (3) Start other food after 3-4 hours of

rehydration

NURSING DIAGNOSIS FOR MARASMUS

Alteration in nutrition less than body requirements related to inadequate food intake (decreased appetite

Impaired skin integrity related to impaired nutritional / metabolic status•

High risk of infection associated with damage to the body's defense•

Lack of knowledge related to its lack of information Changes in growth and development associated with

physical melemahnyakemampuan and dependence

secondary to caloric intake or inadequate nutrition. Intolerance activities associated with

impaired oxygen transport system secondary to malnutrition. (

NURSING MANAGMENT

Lack of knowledge related to its lack of information to increased knowledge of patients and. Determine the level of knowledge of the patient's parents. 

Assess dietary needs and answer questions as indicated. Encourage the consumption of foods high in fiber and fluid intake is adequate.