Nutritional disorders
Malnutrition is a common cause of
child mortality and morbidity. There is a wide spectrum of nutritional
disorders, varying from protein-energy malnutrition to micronutrient nutritional
deficiencies to morbid obesity (see Table 10.1). In non-industrialized nations
malnutrition and associated infection are leading causes of child death.
•
Diets
low in protein, energy, or specific nutrients.
•
Strict
fad or vegetarian diets.
•
Diseases
causing malabsorption (e.g. coeliac disease, cystic fibrosis, Crohn’s disease),
severe GORD, immunodeficiency, chronic infection.
•
Eating
disorders, e.g. anorexia nervosa.
Refer to a paediatric dietician
and review the following:
· Recent weight loss ( 10% over
3mths is suggestive of impaired nutritional status).
•
Accurately
plot serial height and weight (falling across 2 centile lines or below 3rd
centile may indicate nutritional impairment).
•
Percentage
weight for height (= [actual weight/expected weight for height centile] x 100); a value of 90% may indicate
impairment.
• Body mass index (BMI) = weight
(kg)/height (m)2.
• Mid-arm circumference divided by
head circumference (malnutrition if <0.31).
•
Detailed
dietary assessment of 5–7-day food diary.
• Serum albumin.
Kwashiorkor and marasmus usually
occur together. Because of oedema, mid-upper arm circumference is a better
guide to malnutrition than weight. Kwashiorkor
is due to severe deficiency of protein/essential amino acids.
· Clinical
features: growth
retardation; diarrhoea; apathy; anorexia;
•
oedema;
skin/hair depigmentation; abdominal distension with fatty
· liver.
•
Investigations: hypoalbuniaemia, normo- and
microcytic anaemia, ‘fall’ Ca2+,
‘fall’ Mg2+, ‘fall’ PO34– , and
‘fall’ glucose.
•
Marasmus: is due to severe energy (calories)
deficiency.
•
Clinical features: height is relatively preserved
compared to weight; wasted
appearance; muscle atrophy; listless; diarrhoea; constipation.
•
Investigations: ‘fall’ Serum albumin, Hb, U&E, Ca2+,
Mg2+, PO43 –, and glucose; stool M,C&S for intestinal ova, cysts, and parasites.
•
Correct
dehydration and electrolyte imbalance (IV if required).
•
Treat
underlying infection and/or parasitic infections.
•
Treat
concurrent/causative disease.
•
Treat
specific nutritional deficiencies.
• Orally refeed slowly- watch out for refeeding syndrome.
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