Paediatrics: Nutritional disorders

2021-03-04 12:00 AM

Malnutrition is a common cause of child mortality and morbidity.

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 a severe deficiency of protein/essential amino acids.

  • Clinical features: growth retardation; diarrhoea; apathy; anorexia;
  • oedema; skin/hair depigmentation; abdominal distension with fatty
  • liver.
  • Investigations: hypoalbuminaemia, normal- 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+, PO43 –, 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.