Malnutrition

Question 1

What are the effects of malnutrition on health?

Answer 1

Immunity - loss of essential AAs
Growth and development 
Metabolic disturbances
Eyes, thyroid, brain, intestinal epithelia disruption
Hypoglycaemia 
Hypothermia 
Dehydration 
Heart and liver failure from fat degeneration 
Intrauterine development 
Foetal programming 

Malnutrition contributes to 45% of global childhood deaths

Question 2

What are the benefits of breastfeeding?

Answer 2

Reduced risk of IDs and death from them
Hygienic
Free
Bonding
Long term reduces obesity, T2DM and increases IQ

Question 3

What are the recommendations for breastfeeding?

Answer 3

Within one hour of birth
Exclusive for 6 months then with supplements (vit A and iron) for up to 2yrs
Responsive feeding
Varied complementary foods

Question 4

How do you measure acute malnutrition/wasting?

Answer 4

Weight for height

Question 5

How do you measure chronic malnutrition/stunting?

Answer 5

Height for age

Question 6

What is weight for age used for?

Answer 6

Can’t tell between acute and chronic, used as a marker of progress over time

Question 7

What are the features of marasmus?

Answer 7

Old persons face
Extreme wasting
Irritability and alert
Pot belly (weak abdo muscles and gassy from bacterial overgrowth)
Hungry

Question 8

What are the features of kwashiorkor?

Answer 8

Oedema
Moon face
Desquamation
Dry, thin, depigmented hair
Hepatomegaly
Lethargic and apathetic

Question 9

What is complicated malnutrition?

Answer 9

Children who
Fail appetite test or
Have severe oedema or
Have signs of infection or metabolic disturbance

Question 10

How do you manage the complications of SAM?

Answer 10

ABC - manage shock with 15ml/kg over 1hr Ringers + 5%glucose
Hypoglycaemia Mgx- 5ml/kg 10% glucose asap
ReSoMal (less Na, more K) for dehydration +BF
Kangaroo care for hypothermia
IV amox + gent
Albendazole once stabilised
Malaria/HIV test
Transfuse if Hb<4

Question 11

What is the stabilisation phase of SAM management?

Answer 11

3hrly F-75 feeds, via NGT if needed
5mg folic acid on admission
Weigh each morning

Question 12

What is the transition phase of SAM management and when can it be started?

Answer 12

Once appetite returns, oedema starts to go and medical complications treated
Switch to F-100 milk 3hrly, gradually increase volume

Question 13

What is the rehabilitate phase of SAM management?

Answer 13

Increase to over 200ml/kg/d F-100 as 5 feeds/day or RUTF
Give iron unless using RUTF
Give albendazole
Check weight and oedema 3times a week

Once stable refer to an outpatient therapeutic nutrition programme or supplementary feeding programme (if MAM)