This document discusses malnutrition in children. It defines malnutrition as a pathological state resulting from nutrient deficiencies. The objectives are to understand malnutrition, its causes, diagnosis, and treatment. Malnutrition can be caused by inadequate food intake, absorption issues, or diseases. It specifically discusses protein-energy malnutrition (PEM), including kwashiorkor caused by protein deficiency and marasmus caused by energy deficiency. The clinical features, management, and nursing care are outlined for each condition.

1. MALNUTRITION IN
CHILDREN
 Prepared By
 Lamiaa 400@yahoo.com
 Pediatric Nursing

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

9. PROTEIN MALNUTRITIONPROTEIN MALNUTRITION
))PCM or PEM, Protein-Calorie (Energy) MalnutritionPCM or PEM, Protein-Calorie (Energy) Malnutrition,,
KwashiorkorKwashiorkor((

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

14. CLINICAL
MANIFESTATION
Constant or cardinal
manifestation
Usual manifestation

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

18. KWASHIORKOR

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.

23. MARASMUSMARASMUS
(Infantile Atrophy, energy-deficiency(Infantile Atrophy, energy-deficiency
or energy-protein deficiency)or energy-protein deficiency)
-LACK OF CALORIES

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.