This document discusses malnutrition and integrated management of childhood illness. It describes two types of malnutrition: marasmus caused by lack of calories and kwashiorkor caused by lack of protein. Signs, symptoms, prevention and treatment are outlined for each. It also discusses growth monitoring, optimal timing of prophylaxis, immunization schedules, vitamin A supplementation, and checking feeding problems and low weight in non-breastfed infants.

1. “
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Integrated Management of Childhood Illness
MALNUTRITION
TERESITA P. PORTILLO, RM
MNAO/MIDWIFE II

2. When the child has malnutrition?
1. Marasmus- cause by lack of calories or inadequate amount of foods
 Signs and symptoms
-reduce to skin and bones
-resembles on old person with a withered and wrinkled face
 Prevention and treatment
-rush the child to the nearest hospital or clinic for proper diagnosis
and medical treatment
-give cereals, camote, potato, meat and fish, and milk, green and
yellow vegetables

3. 2. Kwashiorkor- cause by severe lack of protein and may occur even if
the child is getting enough calories for energy food
 Sign and symptoms
-swollen face, arms, and legs
-wrinkle muscles with some oozing fats
-thinning hair
-stunted growth
-low resistance against infection
 Prevention and treatment
-rush the child to the nearest hospital or clinic for proper
diagnosis and medical treatment
-give foods rich in fish, meat, chicken

4.  Growth monitoring- is the regular monthly weighing of 0-6
years old children by BNS and BHW to monitor the growth
pattern of the child so that appropriate measure can be
taken and prevent the onset of malnutrition
 OPT- is the quarterly weighing of all 0-71 months old
children in a community to identify and locate the
malnourish children
 Used for nutrition assessment local planning, evaluation and
education
Difference of growth monitoring and OPT

5. COMPUTE FOR AGE IN MONTHS
Year Month Day
2001 11 29
2001 11 10
0 0 19
 Compute the age of the child to the nearest month as the child last birthdate using the formula
Age- no. in years/months/days from the date of weighing minus the date of birth
 Convert age in years into months by multiplying 12. Add the age in months to the product and the
total gives the age in months. Disregard the no. of days.

7. Classify FEEDING(0-2 mos.
Milk incorrectly or unhygienically prepared or
Giving inappropriate replacement feeds or
Yellow:
FEEDINGPROBLEM OR
LOW WEIGHT
Counsel about feeding
Explain the guidelines for safe replacement feeding Identify concerns of mother and family
about feeding.
If mother is using a bottle, teach cup feeding Advise the mother how to feed and keep the
low weight infant warm at home
If thrush, teach the mother to treat thrush at home Advise mother to give home care for the
young infant
Follow-up any feeding problem or thrush in 2 days Follow-up low weight for age in 14 days
Giving insufficient replacement feeds or
An HIV positive mother mixing breast and other
feeds before 6 months or
Using a feeding bottle or
Low weight for age or
Thrush (ulcers or white patches in mouth).
Not low weight for age and no other signs of
inadequate feeding.
Green:
NOFEEDING PROBLEM
Advise mother to give home care for the young infant
Praise the mother for feeding the infant well

8. IMMUNIZATION SCHEDULE: AGE VACCINE VITAMIN
A
Birth BCG OPV-0 Hep B0 200 000
IU to the
mother
within 6
weeks of
delivery
6 weeks DPT+HIB-1 OPV-1 Hep B1 RTV1 PCV1
Give all missed doses on this visit.
Include sick infants unless being referred.
Advise the caretaker when to return for the next dose.
THEN CHECK THE YOUNG INFANT'S IMMUNIZATION AND VITAMIN A STATUS:

9. THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT FOR AGE IN NON-
BREASTFED INFANTS
Ask: LOOK, LISTEN, FEEL:
What milk are you giving? Determine weight for age. How many times during
the Look for ulcers or white day and night? patches in the
mouth
How much is given at each (thrush). feed?
How are you preparing the milk?
Let mother demonstrate or explain how a feed is prepared, and
how it is given to the infant.
Are you giving any breast milk at all?
What foods and fluids in addition to replacement feeds is
given?
How is the milk being given?
Cup or bottle?
How are you cleaning the feeding utensils?

10. CLASSIFY
(2 months
to 5 years
old

11. Give Vitamin A Supplementation and Treatment
VITAMIN A SUPPLEMENTATION:
Give first dose any time after 6 months of age to ALL CHILDREN
Thereafter vitamin A every six months to ALL CHILDREN
VITAMIN A TREATMENT:
Give an extra dose of Vitamin A (same dose as for supplementation) for treatment if the child
has MEASLES or PERSISTENT DIARRHOEA.
If the child has had a dose of vitamin A within the past month or is on RUTF for treatment
of severe acute malnutrition, DO NOT GIVE VITAMIN A.
Always record the dose of Vitamin A given on the child's card.

12. IMMUNIZATION
NIP- National Immunization Program(new)
EPI-Expanded Program for Immunization(Old)
AGE
Birth
6 weeks
VACCINE
BCG*
DPT+HIB-1
OPV-0 OPV-1 HepB0 HepB1
RTV1 PCV1***
VITAMIN A SUPPLEMENTATION
10 weeks DPT+HIB-2 OPV-2 HepB2 RTV2 PCV2
Give every child a dose of
Vitamin A
every six months
from the age of 6
months. Record the
dose on the child's
chart.
14 weeks DPT+HIB-3 OPV-3 HepB3 RTV3 PCV3 Deworming(ROUTINE WORM
TREATMENT)
Give every child
9 months/12 Months Measles **MMR
Albendazole every 6
months from the age
of one year. Record
the dose on the
child's card.