Malnutrition in Children

what is malnutrition

• Malnutrition is Defined as the cellular imbalance between the Body’s Demand and nutritional supply.
• Severe malnutrition is one of the most common causes of child mortality and morbidity.
• Nutrition is necessary for children’s growth and, to maintain specific functions.
• Malnutrition Denote by “undernutrition” generally.
• Malnutrition is a major health problem, especially in developing countries.
• A common form of malnutrition is protein–energy malnutrition.

Classification of Malnutrition

1. Gomez classification

• Gomez’s classification Depends upon weight for age.
• Weight for age (WFA%) =
• WFA%   = 90-100% = Normal

= 76-90% = 1 malnutrition

= 61-75% = 2 malnutrition

Below 60% = 3 Degree malnutrition

1. Water low’s classification

• It is Depend on height for age. (HFA%)
• HFA%=Height of childHeigth of Nchild of same age×100(cm)
• HFA% = >95%   = Normal

90-95% = Mild malnutrition

85-90% = Moderate malnutrition

<85%     = Sever malnutrition.

1. Indian association of pediatric – (Weight for age)

WFA% =        >80% = Normal

71-80%= 1^st Degree

61-70%= 2^nd Degree

51-60%= 3^rd Degree

<50% = 4^th Degree

1. Well come trust classification – (weight for age + edema).

1. WHO classification = only under 5 years child involve

1. Stunting (Height for age)
2. Underweight (Weight for age)
3. Wasting (Weight for height)

Etiology of Malnutrition   

• Poverty
• Low intake of food
• Social and mobility problems
• Socio-cultural beliefs and Political consent
• Digestive Disorder and chromic Eating Disorder
• Social Isolated person. And Alcoholism
• Poor care of mother and child.

Shakir tape

Shakir tape uses to measure the mid-arm circumference the identify malnutrition.

Red = <115mm = severe malnutrition

Orange = 115-124mm = Moderate malnutrition

Yellow = 125-134mm = Borderline malnutrition

Green = >135mm = Healthy.

Bangle test:-

The bangle test is also used the Determine malnutrition status.

• 4cm in Diameter bangle moves above the elbow, its means the child as malnutrition.
• If a 4cm Diameter bangle never cross the elbow, its means the child is healthy

Clinical Feature of malnutrition

The clinical feature of malnutrition is according to the types of malnutrition

1. Clinical features of Mild Nutrition

• Mild malnutrition occurs between a month to 2 years, due to a deficiency of Nutrition for a short time

Symptoms of Mild Nutrition

• Growth failure
• Infection
• Anemia
• Diminished activity

1. Moderate to severe malnutrition

1. Clinical features of Marasmus

• Severe weight loss and wasting
• Marasmus is compensating condition of malnutrition
• Marasmus is a Nutritional emergency
• In marasmus, Muscle and fat wasting occur both. Children and adults.

Symptoms of Marasmus

• Severe wasting present in thigh, arm, and buttocks
• Monkey face/ Old man face
• Baggy pant appearance – due to loss of buttocks muscles
• Loss of axillary fat
• Child looks active
• Edema absent
• Veracious appetite
• Abdominal Distension

1. clinical feature of Kwashiorkor

• Sickness of weaning
• Kwashiorkor occurs between a 1-4-year child
• Growth retardation and mental changes occur.
• In kwashiorkor, inadequate protein intake, presence of edema, and loss of both proteins.
• Kwashiorkor is a non-compensation condition of malnutrition.
• Wasting of muscle

Symptoms of Kwashiorkor

• Moon like face
• Edema
• Skin changes
• Cheilosis
• Forest sign of hair (Flag sign of hair)
• Smooth tongue
• No sign of Hunger
• Less active child
• Decrease GFR
• Edema occurs in the lower extremities but wasting occurs in the upper extremities.

Difference between Marasmus and Kwashiorkor

Management of Malnutrition

ways to prevent malnutrition

Management is divided into 2 phases

a. Initial Phase

1. Rehabilitative Phase
2. Initial PhaseàTreat the malnutrition complication. The Malnutrition complication is

H- Hypothermia

S- Sugar Decrease (Hypoglycemia)

I – Infection

EL – Electrolyte imbalance

DE – Dehydration

D – Deficiency of elements.

Hypothermia – Treat by maintaining a warm chain.

Hypoglycemia – Treat by providing glucose.

• If blood glucose level <20mg/dl à 2 ml/kg/day glucose
• If the blood glucose level is 20-40 mg/dl à 5 gm sugar in 100ml milk
• Check the blood sugar level every 30-45 min.

Infection – Ampicillin 50 mg/kg/6hour

• Amoxicillin 15mg/kg/8 hours
• Amikacin 15 mg/kg/day

Electrolyte Imbalance

• A potassium supplement is necessary
• Potassium = 3-4 meq/kg/day for 2 weeks
• Magnesium = 0.8 – 1.2 meq/kg/day

Dehydration – Dehydration is treated by ORS and RL.

Deficiency elements – Deficiency of the elements are treated by the

• Provide Vit. A and Folic acid, Zinc, Iron, etc.
• Provide Nutritional support and a high-quality diet

Rehabilitation Phase (2-6 weeks)

• Improve weight and build up the body.
• Emotionally and physically prepare the child
• Maintain the healthy and hygiene Diet
• Educate the parents about Home Care
• Prepare for Basic Health Care.

Key Points

• Gomer’s classification of malnutrition is Depend upon the – Weight for age
• Water-low classification of malnutrition Depends upon – Height for age.
• 115-124 mm Diameter of mid-arm Circumference is Denote the – Moderate Malnutrition
• Which Size bangle is used in the bangle test of malnutrition – 4 cm.
• Severe weight loss and wasting is seen in – Marasmus Malnutrition
• Nutritional Disease shows the flag sign of hair – Kwashiorkor.

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