Malnutrition in Children: Causes, Classification, Symptoms, and Treatment

1. Definition:

Malnutrition is a condition in which the body lacks sufficient energy and essential nutrients, leading to stunted physical and intellectual development and impaired health. This is a serious public health issue, particularly among children, resulting in long-term consequences for both individuals and society.

2. Causes of Malnutrition:

2.1 Errors in Feeding Practices:

• Artificial feeding with diluted cow’s milk or sugary rice water: Cow’s milk is low in nutrients and does not meet the needs of young children, especially lacking iron and vitamins. Sugary rice water only provides energy, lacking protein and essential nutrients.

• Introducing complementary foods too early or too late: Introducing complementary foods too early (before 6 months of age) can reduce breast milk intake, leading to a deficiency in natural antibodies and increased susceptibility to infections. Introducing them too late (after 6 months of age) can result in malnutrition as children do not receive sufficient breast milk and other essential nutrients.

• Excessive dietary restrictions: Unnecessary dietary restrictions limiting foods containing important nutrients, such as eggs, meat, and fish, can lead to protein, fat, vitamin, and mineral deficiencies.

• Insufficient quantity and quality of complementary foods: A monotonous diet lacking food diversity, vitamins, and minerals can also contribute to malnutrition.

2.2 Risk Factors:

• Premature birth, low birth weight, and intrauterine growth restriction: Premature infants have immature digestive systems, are prone to infections, and have poor absorption abilities. Intrauterine growth restriction causes a deficiency of essential nutrients during fetal development, leading to health and developmental issues after birth.

• Congenital malformations: Certain congenital malformations affecting the digestive or cardiovascular systems can hinder nutrient absorption, leading to malnutrition.

• Economic hardship: Financial difficulties may prevent families from providing their children with sufficient nutritious food and limit access to healthcare services.

• Poor healthcare services: Lack of information about nutrition, inadequate healthcare services, and limited access to medical care can lead to delayed detection and treatment of malnutrition.

3. Classification of Malnutrition:

3.1 Gomez Classification:

• Grade 1 Malnutrition: Weight is 70-80% of standard weight.

• Grade 2 Malnutrition: Weight is 60-70% of standard weight.

• Grade 3 Malnutrition: Weight is below 60% of standard weight.

Advantages: Simple classification, easy to implement.

Disadvantages: Does not differentiate between acute and chronic malnutrition.

3.2 Welcome Classification:

• Kwashiorkor: Weight is 60-80% of standard weight with edema (swelling).

• Kwashiorkor-Marasmus: Weight is < 60% of standard weight with edema.

• Marasmus: Weight is < 60% of standard weight without edema.

Advantages: Differentiates between severe malnutrition types.

Disadvantages: Does not distinguish between acute and chronic malnutrition.

3.3 Waterlow Classification:

• Wasting: Acute malnutrition. Height > 90% and weight/height < 80%.

• Stunting: Past malnutrition that has recovered. Height < 90% and weight/height > 80%.

• Wasting and Stunting: Chronic malnutrition. Height < 90% and weight/height < 80%.

3.4 WHO Classification:

• Underweight: Weight-for-age < -2SD.

• Stunting: Height-for-age <-2 SD.

• Wasting: Weight-for-height < -2SD.

4. Clinical Manifestations of Malnutrition:

4.1 Early Stage:

• Cessation of weight gain, weight loss.

• Thinning of subcutaneous fat layers.

• Pale skin.

• Delayed walking, decreased activity levels.

4.2 Intermediate Stage:

• Loss of subcutaneous fat in the abdomen, buttocks, and limbs.

• Fastidious eating, intermittent digestive disturbances.

4.3 Severe Stage:

• Edema (Kwashiorkor): Edema in the legs, abdominal distention, dry skin, thin hair, frequent digestive disturbances, enlarged liver due to fatty degeneration.

• Wasting (Marasmus): Complete loss of subcutaneous fat, extreme thinness, skin over bone, aged appearance, minimal digestive disturbances, normal-sized liver, muscle weakness affecting mobility.

5. Impact of Malnutrition on Health:

• Immune System: Weakened immune system, increased susceptibility to infections.

• Cardiovascular System: Weakened heart muscle, reduced cardiac output, increased risk of heart failure.

• Renal System: Decreased glomerular filtration rate and renal tubular function.

• Digestive System: Reduced gastric acid and digestive enzyme secretion, impaired absorption.

• Endocrine System: Disrupted growth hormone and thyroid hormone levels.

• Skin: Damage due to vitamin, zinc, and amino acid deficiencies.

6. Management of Malnutrition:

6.1 General Principles:

• Identify and address the underlying cause of malnutrition.

• Prevent infections.

• Provide appropriate nutritional supplementation.

• Provide nutrition education to families.

6.2 Treatment Protocols:

• Severe Malnutrition:

• Inpatient management with a 10-point protocol.

• Outpatient management with a protocol addressing the underlying cause, infection control, nutritional supplementation, and nutritional education.

• Moderate Malnutrition:

• Home care.

• Nutritional supplements.

• Regular deworming.

• Micronutrient supplementation.

• Nutrition education.

• Complete immunization.

• Early detection and prevention of complications.

• Weekly and monthly weight monitoring.

• Mild Malnutrition:

• Home care.

• Dietary adjustments using the food guide pyramid.

• Continue breastfeeding for 18-24 months.

• Weekly and monthly weight monitoring.

• Early detection of associated risks.

6.3 Notes:

• All children with severe malnutrition are at risk of hypoglycemia, infection, and low potassium and magnesium levels.

• All children with low body temperature should be treated for hypoglycemia and infection.

• Use oral rehydration solutions or nasogastric tubes for fluid replacement; only use intravenous fluids in cases of shock.

• Monitor weight gain after dietary adjustments.

7. Prevention of Malnutrition:

• Exclusive breastfeeding for the first 6 months of life.

• Provide adequate and appropriate complementary feeding after 6 months of age.

• Maintain personal hygiene for children, ensure complete immunization.

• Provide sufficient nutritious food for children, diversify their diets.

• Promote nutrition education and awareness for families.

8. General Notes:

• Early detection of signs of malnutrition, seek medical attention promptly for treatment.

• Adhere to the doctor’s treatment protocol.

• Maintain appropriate dietary and care routines for children after treatment.

9. Conclusion:

Malnutrition is a serious issue that affects the health and development of children. Understanding its causes, manifestations, and management is crucial for preventing and overcoming malnutrition in children.