2. 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.
2
3. HUMAN NUTRITION
Nutrients 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.
5. MALNUTRITIONMALNUTRITION
improper and / or inadequate
food intake
inadequate absorption
of food
Deficient supply of food
poor dietary habitsfood faddism
emotional factors metabolic abnormalities
diseases
6. 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.
7. 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
8. DEFINITIONS OF MALNUTRITION
Kwashiorkor: protein deficiency
Marasmus: energy deficiency
Marasmic/ Kwashiorkor: combination of chronic
energy deficiency and chronic or acute protein
deficiency
10. Clinical syndrome resulted
from a severe deficiency of
protein & inadequate caloric
intake
KWASHIORKORKWASHIORKOR
11. 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 hormones
5) Exercise -- increases need for
alanine
6) Fever -- increases need
7) Growth -- increases need
12. 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
13. 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
15. 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
16. CONSTANT OR CARDINAL
MANIFESTATION
3-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 walk
4- PSYCHOMOTOR CHANGES
Apathy
Lack interest in surrounding
Look sad and never smile
His cry is weak(Moon Face)
17. USUALLY PRESENT
SIGNS
1-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
19. COMPLICATIONS
1) Dehydration
Skin infection
2) Hemorrhage
3) Heart failure
4) Chest infection
5) Permanent mental and physical
disability
Cause of death KWO
1. Recurrent infection
2. Hypoglycemia
3. Heart failure
20. 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.
21. MARASMUS
The term marasmus is derived from the
Greek marasmos, which means wasting or
Starvation.
24. MARASMUS
Definition It is a clinical;
syndrome resulting mainly
under nutrition due to sever
deficiency of protein,fat,and
Carbohydrates inadequate
calorie supply(starvation)
25. ETIOLOGYETIOLOGY 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
26. CLINICAL FEATURES OF
MARASMUS
characterized 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
27. Emaciation
Skin wrinkled
Subcutaneous fat disappears from
abdomen first,Buttocks, then
extremities, and finally face
28. 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.
29. INVESTIGATIONS
FOR PEM
Full blood counts
Blood glucose profile
Septic screening
Stool & urine for parasites & germs
Electrolytes, Ca, Ph &, serum proteins
CXR & Mantoux test
30. 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.
31. 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
32. 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. (
33. 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.