Definition:  Malnutrition is an impairment of health resulting from a deficiency, excess or imbalance of nutrients.

We have described in article :

Common nutritional disorders

Severe Malnutrition

Classify acute Malnutrition

Protein Energy Malnutrition (PEM)


Nutritional disorders in children :

  • Protein energy malnutrition (PEND).
  • Vitamin and other micronutrient deficiency.
  • Nutritional anemia-iron deficiency anemia.
  • lodine deficiency disorder.

Acute malnutrition :

A child will be said to have acute malnutrition, if he/ she has evidence of one / more of the following features – 

1) . Sudden weight loss characterized by 

  • — MUAC <125mm
  • —Weight for length / height < – 2SD

2). Bipedal oedema.

Classification of acute malnutrition : 

  1. Moderate acute malnutrition.
  2. Severe acute amalnutrition.

 severe malnutrition:

  1. Flaky paint dermatosis.
  2. Crazy pavement dermatosis.
  3. Reticular pigmentation.
  4. Mosaic dermatosis.
  5. Depigmentation
  6. Indolent sores and ulcers
  7. Superimposed on infection.

Protein Energy Malnutrition (PEM) :

Definition: Protein energy malnutrition due lack of protem, calorie and other nutrients mostly occur in infants and young children commonly associated with diarrhoea, measles, RTI, TB, worm infestation

Classification of Protein energy malnutrition : 

  1. Kwshiorkor.
  2. Marasmic kwashiorkor
  3. Marasmus
  4. Nutritional dwarfing.
  5. Under-weight child

Management of Protein energy malnutrition : 

Clinical features of Protein Energy Malnutrition:

A) Clinical features of marasmus :

  1. Wasting marked all skin and bone.
  2. Muscle wasting severe.
  3. Growth retardation severe
  4. Slight hair change
  5. Super-added infections are common

B) Clinical features of kwashiorkor :

  1. Oedema present in the lower segment, sometimes face.
  2. Growth retardation less.
  3. Mental changes.
  4. Hair changes.
  5. Mucosal changes: angular stomatitis.
  6. Anorexia
  7. Diarrhoea
  8. Liver may be palpable

Investigations of Protein Energy Malnutrition:

  1. Blood for complete blood count
  2. Chest X-ray P/A view
  3. Throat swab for CS.
  4. Urine R/E and C/S
  5. Stool for R/M/E and CS.
  6. Scrum total protein-albumin globulin ratio, electrolytes

Treatment of Protein Energy Malnutrition:

  1. Correction of water & electrolyte imbalance.
  2. Treatment of infection and worm infestations.
  3. Dietary support 3-4 g protein & 200 Cal/kg body weight/day+ vitamins and minerals.
  4. Prevention of hypothermia
  5. Counsel parents & plan future care including immunization & diet supplements.
  6. Feeding practice should be : 
  • Continue breast feeding
  • Add frequent small feeds.
  • Use liquid diet.
  • Give vitamin A & folic acid on admission.

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