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Chapter: Paediatrics: Gastroenterology and nutrition

Paediatrics: Nutritional disorders

Malnutrition is a common cause of child mortality and morbidity.

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.


 

Causes

 

   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.

 

Assessment of nutritional status

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.

 

Protein–energy malnutrition

 

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.

 

Treatment

 

   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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