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  1. 1. MALNUTRITION IN CHILDREN  Prepared By  Lamiaa 400@yahoo.com  Pediatric Nursing
  2. 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. 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.
  4. 4. MALNUTRITIONMALNUTRITION improper and / or inadequate food intake inadequate absorption of food Deficient supply of food poor dietary habitsfood faddism emotional factors metabolic abnormalities diseases
  5. 5. 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.
  6. 6. 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
  7. 7. DEFINITIONS OF MALNUTRITION  Kwashiorkor: protein deficiency  Marasmus: energy deficiency  Marasmic/ Kwashiorkor: combination of chronic energy deficiency and chronic or acute protein deficiency
  8. 8. PROTEIN MALNUTRITIONPROTEIN MALNUTRITION ))PCM or PEM, Protein-Calorie (Energy) MalnutritionPCM or PEM, Protein-Calorie (Energy) Malnutrition,, KwashiorkorKwashiorkor((
  9. 9.  Clinical syndrome resulted from a severe deficiency of protein & inadequate caloric intake KWASHIORKORKWASHIORKOR
  10. 10. 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
  11. 11.  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
  12. 12. 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
  13. 13. CLINICAL MANIFESTATION Constant or cardinal manifestation Usual manifestation
  14. 14. 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
  15. 15. 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)
  16. 16. 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
  17. 17. KWASHIORKOR
  18. 18. 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
  19. 19. 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.
  20. 20. MARASMUS  The term marasmus is derived from the Greek marasmos, which means wasting or Starvation.
  21. 21. MARASMUSMARASMUS (Infantile Atrophy, energy-deficiency(Infantile Atrophy, energy-deficiency or energy-protein deficiency)or energy-protein deficiency) -LACK OF CALORIES
  22. 22. MARASMUS  Definition It is a clinical; syndrome resulting mainly under nutrition due to sever deficiency of protein,fat,and Carbohydrates inadequate calorie supply(starvation)
  23. 23. 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
  24. 24. 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
  25. 25.  Emaciation  Skin wrinkled  Subcutaneous fat disappears from abdomen first,Buttocks, then extremities, and finally face
  26. 26. 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.
  27. 27. INVESTIGATIONS FOR PEM  Full blood counts  Blood glucose profile  Septic screening  Stool & urine for parasites & germs  Electrolytes, Ca, Ph &, serum proteins  CXR & Mantoux test
  28. 28. 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.
  29. 29. 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
  30. 30. 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. (
  31. 31. 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. 

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