this presentation covers every aspect of malnutrition in children including definition,types,prevention and treatment.

1. UNDERNUTRITION
BY:- KANIKA

2. GENERAL OBJECTIVES
The objective for this presentation is to acquaint
knowledge about UNDERNUTRITION to the pupil and
to gain confidence in speaking in front of public and to
make them aware of this social problem,its prevalence
and factors affecting it.
OBJECTIVES

3. Specific objectives are underlying:
1.To describe about meaning of undernutrition,its epidemiology
and types.
2.To explain about causes of undernutrition
3.To tell about PEM and its types.
4.To tell about micronutrients, and their deficiencies.
5.To explain about nutritional assessment and parameters used.
6.To tell about management measures to be taken.
SPECIFIC
OBJECTIVES

4. INTRODUCTION
 The interaction between
undernutrition and
infection can create a
potentially lethal cycle of
worsening illness and
deteriorating nutritional
status.
 Poor nutrition in the first
1,000 days of a child’s life
can also lead to stunted
growth, which is
associated with impaired
cognitive ability and
reduced school and work

5. MALNUTRITION
 Malnutrition is a condition that results from
eating a diet in which one or more nutrients are
either not enough or are too much such that the
diet causes health problems
• OVERNUTRITION
NUTRIENTS
MORE THAN
REQUIREMENT
• UNDERNUTRITION
NUTRIENTS LESS
THAN
REQUIREMENTS

7. DEFINITON
 UNDERNUTRITION is defined as an imbalance
between nutrient requirements and intake or
delivery that then results in deficits- of energy,
protein, or micronutrients- that may negatively
affect growth and development.
Nutritional
requirements
Intake of
nutrients

8. TYPES OF
UNDERNUTRITION

9. UNDERNUTRITION
GROW
TH
FAILU
RE
MICRON
UTRIEN
T
DEFICIE
NCY
GROWTH FAILURE
ACUTE
MARASMUS
KWASHIORKAR
MARASMIC
KWASHIORKAR
WASTING
CHRONIC
UNDERWEIGHT
STUNTING
MICRONUTRIENT
DEFICIENCY
VITAMINS
DEFICIENCY
MINERALS
DEFICIENCY

10. CAUSES OF
UNDERNUTRITION
BASIC CAUSE
• Socioeconomic status and education level of families
• Women’s empowerment
• Cultural taboos
• Access to water
• Cookingpracties
UNDERLYING
CAUSES
• Food-access to sufficient quality and quantity food
• Care – feeding (breastfeeding &
complementary), hygiene, psychological care and food
preparation
• Health- curative and preventive services available.
IMMEDIATE
CAUSES
• Low dietary intake, delayed complementary feeding
• Low birth weight
• Infection – diarrhea, pneumonia and others (cause loss
of energy)

12. GROWTH FAILURE
 WASTING
low weight for height.
 STUNTING
Low height for age.
 UNDERWEIGHT
Low weight for age.

14. PROTEIN ENERGY
UNDERNUTRITION
 Protein–energy malnutrition (PEM), is a form
of malnutrition that is defined as a range of
pathological conditions arising from
coincident lack of dietary
protein and/or energy (calories) in varying
proportions. The condition has mild,
moderate, and severe degrees.
 PEM can be classified into two types:
Primary PEM
Secondary PEM

15. PROTEIN ENERGY
UNDERNUTRITION
PRIMARY
{This type of protein-
energy malnutrition is
found in children}
KWASHIORK
AR
MARASMUS
SECONDARY
It is caused due
to disorders in
the
gastrointestinal
tract.
It can be caused
due to infections,
hyperthyroidism,
trauma, burns,
and other critical
illnesses.
It decreases
appetite and
impairs nutrient
metabolism.

16. PRIMARY PEM

18. MICRONUTRIENTS
VITAMINS
FAT SOLUBLE
VITAMIN
A,D,E,K
WATER
SOLUBLE
VITAMIN B,C
MINERALS
MACROMINERALS
CALCIUM,PHOPHOR
US,SODIUM,SULFIDE
,CHLORIDE,MAGNES
IUM
MICROMINERALS
IRON,ZINC,COPPE
R,MANGANESE

19. MICRONUTRIENT
DEFICIENCIES DISORDERS

20. VITAMIN A
Vitamin A is a generic term
for many related
compounds. Retinol
(alcohol), Retinal
(aldehyde) are often called
preformed vitamin A.

21. DEFICIENCY OF
VITAMIN A
1. Ocular change-
 Night blindness
 Xerophthalmia
 BITOT’S spots
 Corneal xerosis

22. 2. Extra ocular changes
 Growth retardation
 Acquired immune
deficiency
 Keritinization of
epithelia in RT, GIT &
UT with increased risk
of RTI, malabsorption &
UTI.

23. VITAMIN-D
 Vitamin D is a fat-
soluble vitamin that is
naturally present in a
few foods.
 Vitamin D is available
in 2 forms, which
includes ergocalciferol
(vitamin D2) and
cholecalciferol (vitamin
D3). Cholecalciferol is
the naturally occurring
form of vitamin D. The
ergocacliferol form is
often used as a food
additive.

24. DEFICIENCY OF VITAMIN D

25. VITAMIN E
Vitamin E
helps maintain healthy
skin and eyes, and
strengthen the body's
natural defence against
illness and infection
(the immune system)

26. VITAMIN E DEFICIENCY
Vitamin E deficiency
may cause:-
 Impaired reflexes
coordination
 Difficulty walking
 Weak muscles

27. VITAMIN K AND ITS
DEFICIENCY
 Vitamin K plays a
key role in
helping the blood
clot, preventing
excessive
bleeding.

28. VITAMIN B AND DEFICIENCY
DISORDERS

29. VITAMIN B1{THIAMINE}
• Thiamine is a vitamin,
also called vitamin B1.
• Vitamin B1 is found in
many foods including
yeast, cereal grains,
beans, nuts, and
meat.

30. DEFICIENCY OF THIAMINE-
BERI-BERI
 Occurs in adults when the intake
drops below 1mg/day
. Three forms-dry, wet, acute
 Dry-no edema, severe muscle
wasting, and cardiomegaly.
 Wet-peripheral edema, ocular
paralysis, ataxia and mental
impairment
 . Infantile beriberi more subtle than
adults occurs in breastfed infants of
thiamine deficient mothers.

31. WERNICK’S
ENCEPHALOPATHY
 Wernicke
encephalopathy] is
the presence of
neurological
symptoms caused
by biochemical
lesions of
the central nervous
system after
exhaustion of B-
vitamin reserves.
 Symptoms include:-
 NYSTAGMUS,ATA

32. VITAMIN B3
{NIACIN}
 Vitamin B3 is a
water soluble
vitamin, other name
for vitamin B3
is nicotinic
acid or niacin an
essential nutrient.

33. DEFICIENCY OF NIACIN-
PELLAGRA
 Vitamin B3 deficiency lasting
for few
months causes pellagra
with “four
D” symptoms: dermatitis with
burn-like blisters and later
rough, scaly and painful, but
not itchy, lesions on the sun-
exposed areas (face,
extension side of the
hands/arms and
leg/feet), diarrhea, dementia
and death (if not treated).
Other symptoms may include
fatigue, depression and
memory loss

34. VITAMIN B6{PYRIDOXINE}
DEFICIENCY
 Deficiency can
cause:-
 Peripheral neuropathy
 Seborrheic dermatitis
 Glossitis
 Cheilosis
 In adults, depression,
confusion, and seizures

35. VITAMIN B9{FOLATE}
DEFICIENCY
 Folate deficiency
occurs when there is
not enough folate
present in the body.
This can lead to a
type of anemia called
megaloblastic
anemia.

36. VITAMIN B12{COBALAMIN}
DEFICIENCY
 Deficiency of vitamin
12 is associated with:-
 Perinicious anemia
 Infertility
 Cognitive decline

37. VITAMIN C
Ascorbic acid is a
water-soluble
vitamin and is found
in variable
quantities in fruits
and vegetables and
organ meats (e.g.
liver and kidney)

38. DEFICIENCY OF VITAMIN C-
SCURVY
Early symptoms of
deficiency
include:-
 Anemia
 Myalgia, or pain,
including bone pain
 Swelling, or edema
 Petechiae, or small
red spots resulting
from bleeding
under the skin

40. MINERALS
1. CALCIUM
2. PHOSPHO
RUS
3. SODIUM
4. MAGNESIU
M
5. COPPER
6. IRON
7. ZINC

41. CALCIUM
 Hypocalcemia, commonly
known as calcium
deficiency disease
 A long-term deficiency
can lead to dental
changes, cataracts,
alterations in the brain,
and osteoporosis.

42. PHOSPHORUS
 Phosphorus is a mineral
that’s found in the bones
and processed by the
kidneys.
 A phosphorus deficiency
is uncommon
 Poor diets or eating
disorders may contribute
to a deficiency.

43. SODIUM
 Sodium is an essential
electrolyte that helps
maintain the balance of
water in and around
cells.
 It’s important for proper
muscle and nerve
function

44. MAGNESIUM
 Low magnesium is
typically due to
decreased absorption
of magnesium in the
gut or increased
excretion of
magnesium in the
urine.

45. COPPER
 The whole human
body contains
approximately 100
mg copper and is
found in Muscle,
liver, bone marrow,
brain, kidney, heart,
hair.

46. COPPER DEFICIENCY-WILSON’S
DISEASE
 The abnormal
metabolism of copper
leads to Wilson’s
disease and Menke’
s kidney hair
syndrome.
 Wilson’s disease
 Defect in a gene
encoding copper
binding ATPase of
liver cells leads to
Wilson’s disease.
Wilson’s disease
leads to

47. IRON
 The total body
content of iron is
between 3 and 5 gm,
75% of which is
found in the blood.
 The rest in the liver,
spleen, bone marrow
and muscle

48. IRON DEFICIENCY-ANEMIA
 Anemia is the most
common nutritional
deficiency disease.
 .The main causes of
iron deficiency or
anemia are
 Nutritional deficiency
of iron
 Lack of iron absorption
 Hookworm infection
 Repeated pregnancy
 Chronic blood loss
 Nephrosis
 Lead poisoning

49. ZINC
 Zinc daily requirement
for human
consumption is 10 mg
daily. The main
sources of Zinc
includes grains, beans,
nuts, meat and
shellfish. In humans,
the normal zinc serum
level is 100 mg / day.

50. ZINC
DEFICIENCY
 Zinc deficiency is
characterized by
 Growth retardation,
 Loss of appetite,
and impaired immune
function
In more severe cases,
zinc deficiency causes
Hair loss,
 Diarrhea,
 Delayed sexual
maturation,
 Impotence,
 Hypogonadism in males,
and eye and skin

52. NUTRITIONAL ASSESSMENT
• ANTHROPOMETERYA
• BIOCHEMICAL TESTSB
• CLINICAL EXAMINATIONC
• DIETARY INTAKED
• ECOLOGICAL STUDIESE
• FUNCTIONAL INDICATORSF

53. NUTRITIONAL ASSESSMENT
CLINICA
L
EXAMIN
ATION
• SUBJECTIV
E DATA
• OBJECTIVE
DATA
• PHYSICAL
EXAMINTAI
ON
ANTHRO
POMETR
Y
• HEIGHT
• WEIGHT
• HEAD AND
CHEST
CIRCUMFE
RENCE
• BMI
• MID ARM
CIRCUMFE
RENCE
BIOCHE
MICAL
TESTS
• SERUM
RETINOL
• LEUCOCYT
E
ASCORBIC
ACID
• PROTHRO
MBIN TIME
• SERUM
FOLATE
DIET
ARY
INTA
KE
ECOLO
GICALS
TUDIES
AND
VITAL
STATIST
ICS

54. CLINICAL EXAMINATION
 SUBJECTIV
E DATA
1.Eating patterns
:number of meal ,Kind,
amount, preference,
where is eaten,
religious and cultural
restriction, able to
feed self.
2.Usual weight.
3.Changes in
appetite,,smell,
chewing, swallowing.
4.Recent surgery,
trauma, burns,
infection.
5.Family history and
chronic illnesses: (e.g.
obesity, GI disorder,
DM, HTN,CANCER.)
6. Nausea, vomiting,
diarrhea, constipation.
7.Food allergies or
intolerance.
8.Medication and/or
supplements.
9.Self care behaviors
:who meal preparation
Environment during
meal time
10. Exercise and activity
patterns.
OBJECTIV
E DATA
General
appearance:
provide clues
to overall
nutritional
status.

59. ANTHROPOMETRIC
MEASUREMENTS
WEIGHT AND HEIGHT RATIOS
HEAD CIRCUMFERENCE
CHEST CIRCUMFERENCE
MID ARM CIRCUMFERENCE
BODY MASS INDEX

60. WEIGHT AND HEIGHT VELOCITY
IN NORMAL CHILDREN

61. ANTHROPOMETRY

62. WEIGHT/
RATIO NORMAL MILD MODERATE SEVERE
Wt./ht. >90 80-90 70-80 <70

63. HEAD CIRCUMFERENCE
•The head circumference is
measured by placing the tape over
the occipital protuberance at the
back and just over the supraorbital
ridge and the glabella in front

64. CHEST CIRCUMFERENCE

65. MID ARM CIRCUMFERENCE

66. BMI{BODY MASS INDEX}

67. ROAD TO HEALTH CHART
 The patient-held Road-to-
Health Card is the child’s
formal medical record. It
gives the child’s medical
history, immunisation
record, developmental
milestones and growth
record. Growth is plotted
on a weight-for-age chart
(growth chart) which is part
of the Road-to-Health
Card.

68. LABORATORY AND
BIOCHEMICAL TESTS

69. BIOCHEMICAL TESTS

70. DIETARY INTAKE
 Weighing of raw
food.
 Weighing of
cooked food.
 Oral questionairre

71. ECOLOGICAL
STUDIES
FUNCTIONAL
TESTS
 Food balance sheet
 Health education
services.
 Conditioning
influences.
 Socio-economic
factors.
 The main purpose of
these tests are to
assess the degree of
alteration in
physiological
functions associated
with under and
malnutrition

72. PREVENTION AND MANAGEMENT
OF UNDERNUTRITION

73. IDENTIFICATION
OF AFFECTED
INDIVIDUALS
SPECIAL
FEEDING
PROGRAMMES
HEALTH
EDUCATION

74. IDENTIFICATION OF AFFECTED
INDIVIDUALS
 A survey should be
carried out in order to
identify affected
individuals.
 Regular growth
charting should be
done in children.

75. SPECIAL FEEDING
PROGRAMMES
 Affected individuals
should be
rehabilitated by
providing special
feeding programmes.
 400-600cal/day
should be provided.

76. Target Group Schemes Major Services from Schemes
Pregnant and Lactating Mothers
Integrated Child Development Scheme
ICDS
ICDS: Supplementary nutrition,
counselling on diet, rest and
breastfeeding, health and nutrition
education.
Indira Gandhi Matritva Sahyog Yojana
IGMSY Conditional Maternity Benefit
Reproductive Child Health RCH-II,
National Rural Health Mission (NRHM),
Janani Suraksha Yojana (JSY)
NRHM: Antenatal care, counselling, iron
supplementation, immunisation,
transportation for institutional delivery,
institutional delivery, cash benefit,
postnatal care, counselling for breast
feeding and spacing of children etc.
Children (0-3 years) ICDS
ICDS: Supplementary nutrition, growth
monitoring, counselling health education
of mothers on child care, promotion of
infant and young child feeding, home
based counselling for early childhood
stimulation, referral and follow up of
undernourished and sick children.
RCH-II, NRHM
NRHM: Home-based new born care,
immunisation, micronutrient
supplementation, deworming, health
check-up, management of childhood
illness and severe under-nutrition, referral
and cashless treatment for first month of
life. Care of sick newborns, facility-based
management of severe acute malnutrition
and follow up.

77. Rajiv Gandhi National Creche Scheme
Rajlv Gandhi National Creche Scheme:
Support for the care of children of
working mothers.
Children (3-6 years) ICDS
ICDS: Non-formal preschool education,
growth monitoring, supplementary
nutrition, referral, health education and
counselling for care givers.
RCH-II, NRHM
NRHM: Immunisation micronutrient
supplementation, deworming, health
check-up, management of illnesses and
severe undernutrition
Rajiv Gandhi National Creche Scheme
Rajiv Gandhi Creche Scheme: support for
care of children of working mothers
Total Sanitation Campaign (TSC)/Nirmal
Bharat Abhiyan (NBA)
TSC/NBA: Household-level sanitation
facilities
National Rural Drinking Water Programme
(NRDWP)
NRDWP: Availability of safe drinking
water
School going children (6-14 years) Mid-Day Meals (MDM),
Mid-day meal: Hot cooked meal to
children attending school.
Sarva Shiksha Abhiyan (SSA)
SSA: Support knowledge dissemination
on nutrition by inclusion of Nutrition
related topics in syllabus and curriculums
for formal education, school health check-
up, mid-day meal.

79. HEALTH EDUCATION
PROMOTION OF
BREAST FEEDING
IMPROVING
PURCHASING
POWER. EDUCATION ABOUT
CORRECT
SELECTION OF
FOOD
CORRECTION OF
TABOOS
KITCHEN GARDENING
PLANNING OF
BUDGET
SANITATION
FACILITIES AND
HYGIENE

80. VITAMIN DEFICIENCY MANAGEMENT
VITAMIN A >1 year-2,00,000 IU orally on presentation the
following day.
1 to 4 weeks later.
6mths-1yr 1,00,000 IU <6mths-50,000 IU
VITAMIN D Single oral dose of 60,000 or over 10 days(60,000 IU
daily for 10 days)
VITAMIN K In severe deficiency-2.5 to 5 mg parenterally.
VITAMIN B1 Mild beriberi-5mg/day PO.
Severly ill-10mg iv BD.

82. FEEL FREE TO
ASK QUERIES??

83. QUESTION1:- What is the first step
towards management of
undernutrition?
IDENTIFICATION OF AFFECTED
INDIVIDUALS.

84. Question 2:- What is wasting?
Wasting:
o Low weight for height
o Indicates acute malnutrition

85. QUESTION 3:- What are the
types of primary PEM?
Primary PEM includes:-
Kwashiorkar and marasmus

86. QUESTION 4:- What are the
deficiency disordes of NIACINand
thiamine?
THIAMINE:- BERI-BERI
NIACIN:- PELLAGRA

87. QUESTION 5:- What are the 4
d’s for PELLAGRA?
•DERMATITIS
•DIARRHEA
•DEMENTIA
•DEATH

88. SUMMARY

89. Undernutrition=imbalance
of intake and requirement
of nutrients.
2 types:
Growth
failure{stunting{wasting
and underweight}
Micronutrient
deficiencies
MICRONUTRIENT
FUNCTIONS AND
DEFICIENCIES:-
VITAMIN AND MINERAL
DEFICIENCIES
NUTRITIONAL
ASSESSMENT
ANTHROPOMETERY
BIOCHEMICAL
EVALUATION
CLINICAL EXAMINATION
DIETARY INTAKE
ECOLOGICAL STUDIES
FUNCTIONAL TESTS.
PREVENTIONAND
MANAGEMENT
1.Identification of
affected individuals
2.Special
feedingprogrammes
3. Health education

90. In last i will conclude by saying food is the
basic need and should be met by
everyone in both qualitative and
quantitative aspects.
CONCLUSION

91. BIBLIOGRAPHY
Name of
the Book
Author Publicatio
n
Text book of
community health
nursing
NEELAM KUMARI PV books
Social and preventive
medicine
K. Park BHANOT
WWW. SLIDESHARE. COM
WWW. SLIDEPAYER. COM
WWW. MEDICINENET. COM