2. :
Defined as lack of macronutrients(calories)
and micronutrients(vitamins,minerals)needed
for body growth.
CAUSES
Diet
Ilness
Water borne diseases
Limited access to clean water
Social economic status
Poor maternal health
3. Main causes of deaths in under-fives (2000)
4%
Pneumonia
22%
Diarrhoea
12%
Malaria
8%
Measles
5%
HIV/AIDS
Perinatal
22%
Other
29%
Deaths
associated with
malnutrition
60%
9. REDUCTIVE ADAPTATION IN
SM
Systems of the body begin to “shut down”
Systems slow down and do less in order to
allow survival on limited calories
This slowing down is called reductive
adaptation
10. SM CHILDREN KEEP THE ESSENTIAL
ORGANS WORKING BY:
Reducing the amount of energy used. Body may:
-stop growing
-decrease physical activity
-decrease the work of some organs (heart, liver and
kidneys)
-reduce activity inside cells(slow rate of pumping
K in and Na out)
-decrease the body’s response to infections (no
fever)
Using body fat and breaking down muscle and
other tissues for energy
11. MALNUTRITION CAUSES VISIBLE
CHANGES
Appearance – very thin and loose skin
oedema due to excess fluid
skin and/or hair changes due
cell damage
Appetite - poor appetite, may be due to
infections
Mood -miserable, irritable and apathetic
12. MALNUTRITION CAUSES INVISIBLE
CHANGES (1)
Liver cannot cope with large amount of
protein in the diet and also makes less
glucose
The heart is smaller and weaker, cannot
pump strongly and cannot deal with excess
fluid in blood
13. MALNUTRITION CAUSES INVISIBLE
CHANGES (2)
The kidneys cannot get rid of excess fluid
or sodium
The cell walls are “leaky”. K and Mg leak
out ( and excreted) and Na leaks in. So
body contains too little K and Mg and too
much Na, causing oedema
The immune system is less efficient
14. WHY SEVERELY MALNOURISHED
CHILDREN NEED DEFFERENT CARE
Loss of muscle and damaged liver increase the
risk of hypoglycaemia
Loss of body fat and low activity increase risk of
hypothermia
The gut and liver cannot cope with normal meals
The heart easily goes into heart failure if too much
fluid is given
Loss of fat and muscle makes it difficult to
diagnose dehydration
The inefficient immune system give a weak
response to infection so may be missed
15. SEVERELY MALNOURISHED
CHILDREN MUST BE:
Fed differently from other children
Rehydrated differently
Treated with antibiotics even if there are no
clinical signs of infection
Given specific nutrients to correct electrolyte and
fluid imbalances and repair damaged cells and
organs
Given special care (not kept waiting for
admission, kept warm)
16. Where should children be treated ?
Stabilisation phase: needs inpatient
treatment
Rehabilitation phase: can be at home (i.e.
community-based) if the family has the
resources and time, and if the child’s
progress can be monitored
18. Risk of hypoglycaemia
Poor treatment practices
kept waiting
– in queue
– to be examined by doctor
– to get to ward
not fed at night
not tube fed if anorexic
19. Risk of hypothermia
Poor treatment practices
not fed every 2-3 hours
draughty, cold wards
no blankets
left in wet clothes
20. Risk of cardiac failure
Poor treatment practices
too much fluid
dehydration overestimated
IV route used inappropriately
not monitored during rehydration
Na not restricted
K deficiency not corrected
diuretics given to get rid of oedema
23. 10 Steps
STABILISATION REHABILITATION
Week 2-6
1. Treat/prevent hypoglycaemia
2. Treat/prevent hypothermia
3. Treat/prevent dehydration
4. Correct imbalance of electrolytes
5. Treat infections
6. Correct deficiencies of micronutrients no iron with iron
7. Start cautious feeding
8. Rebuild wasted tissues (catch-up growth)
9. Provide loving care and play
10. Prepare for follow-up
Day 1-2 Day 2-7+
24. Feeding
Stabilisation phase
Target is:
100 kcal/kg/day 1g protein/kg/day
Give F75 (75 kcal and 0.9g protein/100ml)
Rehabilitation phase (catch-up growth)
Target is:
150-220 kcal/kg/day
4-6 g protein/kg/day
Give F100 (100 kcal and 2.9g protein/100ml)
or RUTF (ready-to-use therapeutic food)
or modified family foods
25. STABILIZATION PHASE 1-7 days
Treat infections and other urgent medical
problems
Provide sufficient energy and nutrients to stop
further loss of muscle and fat
Çorrect electrolyte imbalance
Get rid of oedema
Get the organs and cells working again
100kcal/kg/day, 1g protein/kg/day
F-75 (75kcal/100ml, 0.9g protein/100 ml)
26. F-75 RECIPE
Dried skimmed milk 25g
Sugar 200g
Vegetable oil 60g
CMV(minerals and v itamins) 1
scoop
Water to make 2000ml
In case of osmotic diarrhoea, replace 60g of sugar
with 70gm of cereal (maize meal) – makes cereal
based F-75 (Osmolarity 300mOsmol/l)
27. REHABILITATION PHASE 2-6weeks
Provide extra energy and nutrients for rapid
weight gain
Give stimulating play to improve mental and
motor development
Make sure the carer and family know how to care
for the child at home
150-220kcal/kg/day, 4-6g protein/kg/day
F-100 (100kcal/100ml, 2.9g protein/100ml)
Or RUTF (Ready to use therapeutic food)
29. COMPLICATIONS OF
MALNUTRITION
HYPOGLYCEMIA
10%dextrose and feed especially in the night
HYPOTHERMIA
Warm clothes,warm room and feed them
ELECTROLYTE IMBALANCE
Ringers lactate for potassium loss
INFECTION
Give antibiotics
DEHYDRATION
Ringers lactate and RESOMAL
30. MICRONUTRIENT
Iron,folate and vitamin B12
INITIAL FEEDING
Give f 75 if cant feed use NGTUBE
CATCH UP GROWTH
F100 formular
SENSORY STIMULATION
Give love gifts.tender love and care
FOLLOW UP
When to get back
33. Local production of
Ready to Use Therapeutic Food (RUTF)
Groundnuts
Milk powder
Oil
Sugar
Vitamins / minerals
34. Local production of
Ready to Use Therapeutic Food (RUTF)
Groundnuts
Milk powder
Oil
Sugar
Vitamins / minerals
35.
36. Summary
Malnutrition contributes to over half of all child deaths
prevention
timely treatment in the community
improved inpatient management
Severely malnourished children are different from other children. They need
different care, because of the physiological and metabolic changes that occur
Most severe malnutrition deaths are preventable if treatment guidelines are
followed.
