Malnutrition in children

1. Malnutrition
By
Dr. Imran Mahmood
Associate Professor
Department of Pediatrics
Fazaia Medical College, Islamabad

2. Learning Outcomes
 Types of malnutrition---Primary and secondary and their causes
 Classification of malnutrition
 Clinical signs of malnutrition
 Difference b/w marasmus and Kawashiorkor
 Micronutrient deficiencies
 Investigations of malnutrition
 Management:
 In ER
 Immediate management
 Discharge
 Follow-up.

6. Types of Malnutrition
 Primary Malnutrition
 Poverty
 Mother
 Ill, working, incompetent
 Father
 Ill, unemployed, addict
 Parental loss
 Death, divorce, seperation
 Failure of lactation
 Ignorance of weaning
 Cultural patterns and food fads
 Lack of immunization and
primary care
 Lack of family planning
 Secondary malnutrition
 Infections
 Parasite, measles, TB
 Congenital diseases
 CHD, hydrocephalous, cleft palate,
hypothyroidism
 Malabsorption
 Celiac, Giardiasis, Lactose
intolerance, CF, post NEC, short gut
syndrome.
 Metabolic disorders
 Storage disorders, DM,
Galactosemia
 Chronic diseases
 Chronic kidney disease, cholestasis,
Down syndrome, malignancy, HIV,
Thyrotoxicosis
 Child abuse.

11. MID ARM CIRCUMFERENCE
mid arm
circumference
Degree of
malnutrition
Degree of
malnutrition
14 – 16.5 cm Up to green colour Absent
12 – 14 cm Yellow colour 1st and 2nd degree
malnutrition
<12 cm Red colour 3rd degree malnutrition

16. Marasmus
 Wise old man look
 Gross loss of subcutaneous
fat
 Loose hanging skin folds in
the axillary, inguinal and
buttock region
 Prominent eyes
 Alert look
 Good appetite
 No edema
 No skin and hair changes
Kwashiorkor
 Sugar babies
 Generalized edema (pitting
oedema over the ankles)
 Discoloured easily pluckable
hair (flag sign)
 Skin changes (flaky paint
dermatitis)
 Apathic irritable, with poor
appetite
 Hepatomegaly
 Multiple nutrient deficiencies
 Hypoprotinemic
 High serum lipoproteins

18. Micronutrient Deficiencies

36. Acrodermatitis Enteropathica
 Autosomal Recessive
 Defect of Zinc absorption
 Begins within 2-4 weeks of
weaning
 Perioral and perianal
dermatitis

55. References
 Nelson Textbook of Pediatrics, 20th Edition.
 Basis of Pediatrics by Dr. Pervez Akbar, 10th Edition.

57. Questions and comments?