This document discusses malnutrition, including its types, causes, classifications, signs, and treatments. It defines primary malnutrition as caused by poverty, parental issues, or cultural factors and secondary malnutrition as caused by infections, diseases, malabsorption, or metabolic disorders. The document classifies malnutrition by mid-upper arm circumference and describes the differences between marasmus and kwashiorkor. It also discusses micronutrient deficiencies like zinc deficiency which can cause acrodermatitis enteropathica. The management of malnutrition involves immediate treatment in the emergency room as well as long-term follow-up.

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?