Paediatrics: Nutritional disorders

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⁺, PO₄^{3 –}, 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.