WHAT YOU NEED TO KNOW ABOUT MALNUTRITION!

Malnutrition is  a global issue but more common and devastating in developing nations where it is underlying and contributory to more than 50% of deaths of in children below the age of 5 years. It affects growth, development, immunity and learning abilities of children.

Dr Nwaoma Nwaogu, Consultant Paediatrician discussed this topic in one of our ATP group discussions recently which has now been summarized into this article.

Malnutrition, simply put, is lack of proper nutrition.

WHO refers to it as deficiencies, excesses or imbalances in a person’s intake of energy and or nutrients. There are different forms of malnutrition

• Macronutrient deficiencies e.g. protein, carbohydrates,
• Micronutrients e.g. vitamins, zinc iron deficiencies
• Overweight and obesity is a form of malnutrition.

What are the common causes of malnutrition?

These can be grouped into three main categories:

• inadequate intake
• increased loss
• factors external to the child.

Inadequate intake:

• Food unavailability
• Inadequate quantities
• Food taboos
• Ill health from any reason can contribute to inadequate intake of food.

Increased loss

• Chronic or recurrent diarrhoea.
• Problems with digestion and absorption of food already eaten can lead to loss of nutrients too.
• Infections e.g. TB, Measles
• Infestation e.g. hookworm infestations
• Chronic conditions that affect appetite and metabolic processes in a child. e.g. sickle cell anaemia, congenital heart disease etc

Social contributors

• Poor sanitation/hygiene and dirty environment which call provide the conducive atmosphere for infection to thrive
• Uneducated mother
• Teenage mother
• Ignorant mother
• Absentee mother e.g. a mother with mental ill health

Symptoms and signs of Malnutrition

The tell-tale signs of severe malnutrition include :

• Head: thin hair, discoloured hair, sparse and brittle hair, prominent bones
• Face: prominent bones, pale conjunctiva, oral lesions/ mouth sores
• Skin: hanging skin, rashes/lesions, wounds that won’t heal
• Limbs: thin bones and sometimes, swollen limbs; what we call oedema.

However children may have mild form of malnutrition with other subtle signs:

1. Weight and height that are low for age of the child.
2. Skin signs
3. Bow legs
4. Clothing becoming loose
5. Child always tired/fatigued
6. Hair  and nail changes

Management of a child with malnutrition should be at the hospital by a Paediatrician and Nutritionist (Dietitian)

Prevention of Malnutrition

1. Exclusive breastfeeding for the first 6 months of life and adequate complementary diet beyond 6 months. This entails giving the right balance of nutrients in the right quantity, right texture/consistency, right frequency and right density/volume. You should read the article INFANT FEEDING IN THE FIRST 1000 DAYS for more information on this.
2. Immunizations – this fight all diseases that are vaccine preventable.
3. Personal and environmental hygiene. Hand washing and proper handling of sewage and other household waste including proper waste disposal. You should wash your hands with every diaper change; before making the child’s food and afterwards.
4. Health Education: this article is based on parents health discussion handled by our Paediatrician on Ask The Paediatricians Facebook group. It is important to learn more about child health issues on such platforms and websites like this. You should also spread the right information. What are the available local food options? What fruits are in season, do you know how to prepare ORS and administer to a child with watery stools? All these we must learn and teach others.
5. Family planning: You should space your children and have the number of children you can cater for properly.
6. Clean water: It is important to make sure the child drinking water is boiled or sterilised using appropriate agents e.g. water guard
7. Proper antenatal care: A malnourished mother will produce a malnourished low birth weight infants

If you are concerned about malnutrition in your child, please see a Paediatrician immediately. If you have any questions, you can ask in the comments. For urgent questions, this can be asked in our Facebook community group from Mondays to Saturdays. Remember to follow us on all our social media handles and join us every Monday at 6pm for the Ask The Paediatricians LIVE. Past episodes can be watched on our YouTube channel.