1. Protein-Calorie Malnutrition (PCM)

2. adequate and balanced intake of foods obtain the nutrients (protein, fat, water, vitamins, minerals) growth development normal metabolic functions

3. a substance obtained from food and used in the body to promote growth, maintenance, and repair of body tissues “ a substance that provides nourishment” Nutrient

4. energy-producing nutrition carbohydrates, fat and protein Micronutrients vitamins and minerals two groups

9. The single largest common denominator in global child deaths is malnutrition 9.7 million under five deaths in 2006

10. PCM affects 1/4 child “ The silent emergency ” is an accomplice in at least 5.2million child death each year

14. dietary deficiency influence of diseases Physiological dysfunction Etiology

15. poverty cultural practices using foods of low-nutrient density child abuse anorexia of psychic or physical origin absence or prolonging of breast-feeding without the addition of supplementary diets poor dietary habits Dietary deficiency

17. social and cultural factors also contribute significantly to the overall picture of Malnutrition ignorance superstitions wrong food beliefs

19. Gastrointestinal infection Congenital defects of anatomy or metabolism Infectious diseases Influence of diseases

20. harelip Cleft palate

21. Children with Intestinal Parasites

27. Nutrition in the Life Cycle

28. In mild and moderate PCM decrease in subcutaneous fat mild muscular atrophy In severe PCM thin intestinal mucosa disappearance of mucosal plicae cloudy swelling of myocardial fibers fatty infiltration of liver atrophy of lymphoid tissue and thymus Pathogenesis and pathophysiology

29. Carbohydrate metabolism Hypoglycemia commonest feature anorexia, insufficient food intake insufficient or over utilization of glycogen Protein metabolism Insufficient ingestion of protein serum total protein and albumin total protein is <40g/l and/or albumin is <20g/l hypoprotein edema. Metabolic disturbances

30. Fat metabolism Large amount of fat utilized cholesterol liver Fatty infiltration and degenerative Fluids and electrolyte disturbances The total water content is relatively increased hypotonic extracellular fluid Hypotonic dehydration acidosis hypopotasaemia hypocalcemia hypomagnesemia Metabolic disturbances

31. Gastrointestinal hypofunction digestive juice enzyme volume enzyme activity peristaltic function digestive function diarrhea occurs Circulatory hypofunction cardiac contractility cardiac output blood pressure Pulse is week. Hypofunction of tissues and organs

32. Renal hypofunction kidney function the ability to concentrate the urine gravity of urine Central nervous system excitability decreased depression restlessness Hypofunction of tissues and organs

33. Immune function Both nonspecific and specific immune functions are low poor defensive function of skin and mucous membranes phagocytic function of the polymorphonuclear leucocytes and complement function are reduced. humoral and cellular immunity are reduced Sensitization response to antigen and cutaneous hypersensitivity is delayed. Mantoux test is negative even when the child has tuberculosis . Hypofunction of tissues and organs

34. Less or no gain in body weight Height sometimes is lower than normal. Subcutaneous fat decreases or disappears. The order of disappearance of subcutaneous fat is: abdomen -> trunk -> buttocks -> extremities -> face . Clinical manifestation

35. measure the subcutaneous fat of the abdominal region On nipple line beside the umbilicus 3cm perpendicularly

36. anorexia, lethargy, apathy, or irritability inadequate growth, lack of stamina loss of muscular tissue the muscles are week, thin, and atrophic the hair sparse , thin, loses its elasticity hair texture becomes coarse in chronic disease. nutritional edema infections and parasitic infestations are common mental changes, stupor, coma, and death Clinical manifestation

37. Marasmic type : due to lack of total calories, protein and vitamins. Edematous type : it is caused by severe protein deficiency despite fair-to-normal calories. Also known as nutrition edema. Kwashiorkor syndrome is one type of nutrition edema. PCM is divided into 2 types

38. Severe growth failure and emaciation are the most striking characteristics of the marasmic infant. MARASMUS

39. 1st degree 2nd degree 3rd degree (mild) (moderate) (severe) loss of body 15%-25% 25%-40% >40% subcutaneous 0.8-0.4cm <0.4cm disappear height normal <normal below p 3 marasmus no obvious obvious “skin and bone” skin near normal slight pallor, severe pallor,shrivel, loose elasticity decreased muscular tone normal muscular flabby muscles thin and atrophy muscular tone decreased motional inactive listlessness apathy, irritability, reaction depressed slow reaction MARASMUS

50. Marasmus differs from kwashiorkor in several important aspects : Marasmus Kwashiorkor 1. The onset is earlier, usually in the first year of life Onset is later, after the breast-feeding is stopped. 2. Growth failure is more pronounced. Not very Pronounced . 3. There is no edema Edema is present. 4. Blood protein concentration is reduced less markedly. Blood protein concentration is reduced very much. 5. Skin changes are seen less frequently. Red boils and patches are classic symptoms . 6. Liver is not infiltrated with fat Fatty liver is seen. 7. Recovery is much longer. Recovery period is short .

51. Infection: diarrhea pneumonia tympanitis otitis media Iron deficiency anemia Vitamin deficiency Hypoglycemia shock Complication

52. malnutrition reduces T lymphocytes, impairs antibody formation, decreases complement formation, and causes atrophy of lymphoid tissues—all necessary in combating infection malnutrition isn’t just a risk factor for increased mortality and morbidity, but also a barrier for effective treatment of infectious diseases

54. concentration of serum albumin Ketonuria is the early stage of inanition but frequently disappears in the later stages Blood glucose values are low Laboratory data

55. Plasma values of essential amino acids may be decreased relative to nonessential ones, and there may be increased aminoaciduria . Potassium and magnesium deficiencies are frequent. Bone growth is usually delayed. Anemia may be normocytic, microcytic, macrocytic. vitamin and mineral deficiencies Laboratory data

56. history of feeding loss body weight decrease in subcutaneous fat function disturbance of different organs Diagnosis

59. Malnutrition Among Children Percent Children under age 3 Underweight stunting wasting

60. Strengthen child health care have good nursing care proper feeding since newborn propagate the knowledge of infant feeding to mothers. Prevention

61. Breast feeding must be encouraged in infants especially in prematurity. artificial feeding instructions should be given to mothers for adequate volume and dilution of milk powder or cow’s milk , supplementary food including vitamins and minerals. Food begin from fluid to solid after weaning. Prevention

62. Children 1-7 months who were breastfeeding poorly were 5.5 times more likely to die than those feeding normally

63. Rational living schedules Enough sleeping time good hygienic habits outdoor activities and exercises Prevention

64. Correct of congenital defects Harelip cleft palate hypertrophic pyloric stenosis Prevention

66. Treatment of primary disease Nutritional therapy Treatment of complications Intensive nursing Treatment

67. Nutritional Therapy Improvement of feeding regulation of diet Enough energy and protein Principle: individual supply gradual increase in diet maintain on positive nitrogen balance Treatment

68. Choice of food Breast feeding is the best Food are easily digested and high nutrition, high protein, high calorie , high vitamins Adding supplement should gradually Treatment

70. The energy content of human milk = 640 kcal/L A 780 daily intake would provide 500 kcal The protein content of human milk varies from 9.4 –12.9 g/L A 780 ml daily intake would provide 6.7-10.0 gr

74. Percent of Breastfed Children Given Solid/Mushy Food Percent Months Should begin solid/mushy food at4-6 mos.

75. Methods mild or moderate malnutrition may be oral severe may be nasal feeding, elementary diet, or total parenteral nutrition. Treatment

76. 1st degree 2nd degree 3rd degree calorie 120->140->120 60 ->120->140 35 ->60->120 (kcal/kg.d) ->174->120 ->140->174->120 protein 3->3.5 2 ->3->3.5 1.3 ->2->3->3.5 (g/kg.d) ->4.5->3.5 ->4.5->3.5 fat 1.8->2.8->3.5 1.0 ->1.8->2.8 0.4 ->1->1.8 (g/kg.d) ->7->3.5 ->2.8->7->3.5 carbohydrate 11 ->23->25 6.5 ->11->23 (g/kg.d) 23->25->14 ->24->14 ->25->24->14

77. Dietary Increase number and variety of food offered Increase energy density of usual foods (add cheese, margarine and cream) Behaviour Have meals at regular times, eaten with other family members Praise when food is eaten Gently encourage child to eat ,but avoid conflict Never force-feed Strategies for increasing energy intake

78. Encourage digestion and improve metabolic function Drug therapy a. Digestive enzymes i.e. peptin ,trypsin b. Vitamins, especially A,D,E,K, c. Micro-elements d. Insulin 2-3u e. Traditional medicine Nutritional Therapy Treatment

80. Supporting therapy Treatment of complications Small and repeated doses of blood and plasma infusions TPN Treatment

81. c lean and comfortable environment f resh air and enough sunlight a dequate room temperature p rotective isolation Intensive nursing Treatment