1 / 142
E N D
Nutritional deficiencies in children………… Presented By, Mariya Antony 3rd Year BSc Nursing STCON
Can you list the different nutritional deficiencies……………….???????????
Protein – Energy Malnutrition • Introduction: • The term refers to a group of related disorders that include • Marasmus, • Kwashiorkor • Marasmic-kwashiorkor.
1. Marasmus This term is derived from Greek word ‘Marasmos’, which means “withering or wasting”. It occurs due to inadequate intake of proteins and calories and is characterized by emanciation.
2. Kwashiorkor • This word means “sickness of weaning “. • It involves inadequate intake of proteins and is characterized by presence of edema.
Classification of pem • 1. Weight for age classification by Gomez: Weight for age = Weight of the child *100 Weight of normal child of same age
If weight for age is: • >90% = Normal nutritional status • 76-90% = 1ST degree malnutrition • 61-75% = 2nd degree malnutrition • < or = 60%= 3rd degree malnutrition
Waterlow’s classification on the basis of height for AGE Height for age(%)= Height of the child *100 Height of the normal child for same age
If , height for age is • >95% = Normal • 90-95% = Mild malnutrition • 85-90% = Moderate malnutrition • <85% = Severe Malnutrition
Classification given by Indian Academy of Pediatrics (IAP) on the basis of Weight for age. • The IAP takes weight of more than 80%of the expected weight for age, as normal . The grades of malnutrition are:
4) Wellcome Trust Classification on the Basis of Weight for Age and Presence of Edema:
5)Who classification • Stunting : It is defined as height for age being 2 standard deviation below from median height for age in NCHS reference population. • Underweight : If the weight for age is 2 standard deviation below from median weight for age , given NCHS reference population , is termed as undernutrition. • Wasting: Of the weight for age is 2 standard deviation below from median weight for height, given in NCHS reference population, it is termed as wasting.
etiology • Multifactorial • Worldwide the most important cause is inadequate food intake . • Ineffective weaning secondary to ignorance, economic, and cultural factors • Gastrointestinal infections • Parasitic infections • Fat diets • Inappropriate management of food allergies • Psychiatric diseases
Developed countries: • Cystic fibrosis • CKD • Childhood malignancies • Congenital heart disease • Neuromuscular diseases
Preschool children are at high risk • Dependence on others for food • Increased protein and energy requirements • Immature immune systems causing greater susceptibility to infection • Exposure to non hygienic conditions
Clinical manifestations COMPARISON…
Diagnostic evaluation • Health history • A thorough physical examination • Anthropometric assessment • PBF • Stool examination • Blood hematology and biochemistry • Blood glucose • S. albumin • Blood hb • S. electrolytes • S. cholesterol • Blood ph • Urine examination
Management • Two phases: • Initial phase • Rehabilitation phase
Initial phase • Treatment of complications • Correction of nutritional deficiencies • Reversal of metabolic abnormalities • Beginning of feeding
1)Treatment of complications • S – Sugar level of blood is low • H – Hypothermia • I – Infections • EL – Electrolyte • DE – Dehydration • D - Deficiency
A) Hypoglycemia • 10% glucose is administered • B) Hypothermia • KMC • Warm blankets • Monitoring of rectal temperature • C)Infections • Antibiotics • Minimum visitors • Aseptic techniques
D) Electrolyte disturbances • Restriction of salt intake • Potassium supplementation: 30-40meq/l • Calcium supplementation • E) Dehydration • Mild : ORS • Rehydration solution :70-100 ml/kg For period of 12 hrs
Moderate to severe dehydration and shock; • Initially RL or N/2 saline : 30Ml/kg Body weight in 2 hrs, • followed by N/6 saline in 9% dextrose in a dose of 100 ml/ kg BW, in next 10 hrs. • For next 12 hrs , Same solution is at rate of 5ml/kg BW per hr. • After Dehydration: Maintenance fluid N/6 Saline in 5% dextrose at 100 ml/ kg /day , till feeding is started
F) Deficiencies • Administration of vitamin A : • Infants below 6 months: 500000 IU • 6-12 months: 1 lakh IU • children above 1 yr: 2 Lakh IU • Folic acid : 5 mg on first day followed by 1 mg/ ady • Vitamin K : IM, 2.5 mg
E) Initiation of feeding: • B – Beginning of feeding • E – Energy dense feeding • S – Stimulation of emotional and sensorial development • T – Transfer of home based diet before discharge
Rehabilitation phase • Recovery of lost weight • Emotional and physical stimulation • Training the mother of domiciliary care • Preparation for discharge
Therapeutic diet : • 175-200 kcal/kg/day • Protein: 4-5 g/kg/day • Fluid : 150ml/kg/day • Weight gain : 10-20 gm/kg/day
Recovery and discharge • 6-8 weeks for recovery • Periodically follow up: 8-36 weeks after discharge
prevention • Prevention at home level
Vitamin deficiencyfat soluble vitamins Vitamin A
forms • Vitamin A (Retinol) • Vitamin A2 • Vitamin A aldehyde • Vitamin A (retinoic acid)
Causes for deficiency • Malnutrition • Malabsorption • Breast milk • Zinc deficiency • Iron deficiency
Clinical manifestations XEROPHTAHLMIA NIGHT BLINDNESS XEROSIS CONJUNCTIVA
XEROSIS CORNEA BITOT’S SPOT
KERATOMALACIA GROWTH RETARDATION FOLLICULAR HYPERKERATOSIS IMPAIRED IMMUNITY
Vitamin A deficiency resulting in Infections Retinoic acid binds the promoter region of specific genes Activates the transcription process Cell replication Vitamin A deficient diet will have a very limited amount of retinol
Cell proliferation and replication will be suppressed Reduce number of T cells and lymphocytes Suppression of this may result in lack of immune reaction if pathogens enter the body Greater susceptibility to infections
Other symptoms… • EYES • Blurred vision • Bulging eyes • Cataract, conjunctivitis • Cross eyes • Amblyopia • Glaucoma • Itching , burning and watery eyes • Retinal detachment
