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Management

1) Mild and moderate malnutrition account for over 80% of malnutrition deaths and require intervention like adequate protein and calories. 2) Severe malnutrition involves stabilization and rehabilitation phases including treating hypoglycemia, hypothermia, dehydration, and infection. 3) Prevention strategies exist at national, community, and family levels through programs like ICDS that provide nutrition supplementation and education.

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Mayank Pratap Singh
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213 views

Management

1) Mild and moderate malnutrition account for over 80% of malnutrition deaths and require intervention like adequate protein and calories. 2) Severe malnutrition involves stabilization and rehabilitation phases including treating hypoglycemia, hypothermia, dehydration, and infection. 3) Prevention strategies exist at national, community, and family levels through programs like ICDS that provide nutrition supplementation and education.

Uploaded by

Mayank Pratap Singh
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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MALNUTRITION

MANAGEMENT OF

MILD AND MODERATE NUTRITION


Mild and moderate malnutrition make up for more than 80% of malnutrition associated deaths.Thus,intervention is necessary. TREATMENT 1)Provision of adequate protein and energy.150 kcal/kg/day is needed. 2)OIL is is usually used. 3)Protein intake of 3g/kg/day is sufficient.MILK is most popular source.

4)Adequate minerals and vitamins should be provided. 5)Best measure of efficacy of treatment is weight gain

SEVERE MALNUTRITION
HISTORY:attention

should be given to 1)Usual diet and breastfeeding 2)Presence of diarrhoea 3)History of vomiting,loss of appetite,chronic cough 4)Contact with tuberculosis 5)Family history,HIV infection and socioeconomic details should be asked.

EXAMINATION
Anthropometric

made. Clinical features shown to be prognostic are: 1)signs of dehydration 2)shock(cold hands,slow capillary refill,weak and rapid pulse) 3)severe palmar pallor

measurements should be

4)eye signs of vitamin a deficiency 5)signs of infection in ears and throat 6)skin infection or pneumonia 7)fever 8)hypothermia(rectal temperature<35.5 C),mouth ulcers,skin changes)

MANAGEMENT
It involves 10 steps including STABILIZATION and REHABILITATION phases HYPOGLYCAEMIA Blood glucose level less than 54mg/dl or 3mmol/l.Hypoglycaemia,Hypothermia and infection occur as a triad. TREATMENT 1)In asymptomatic condition a) Give 50 ml of 10% glucose orally or by naso gastric tube. b) Feed with starter F75 every 2 hourly day and night.

2)in

symptomatic hypoglycaemia a) give 10% glucose dextrose i.v 5ml/kg b)Follow with 50 ml of 10% dextrose or sucrose solution by nasogastric tube c)Feed with f75 starter 2 hourly day and night d)Start antibiotics e)Prevent hypothermia

HYPOTHERMIA
Rectal temp <35.5 C or axillary temp <35 C TREATMENT Clothe cjild with warm clothes,cover head with scarf,provide heat source and avoid rapid rewarming as this may lead to disequilibrium. Feed the child and give antibiotics

PREVENTION Place childs bed in draught free area Kangaroo mother care to provide warmth Feed child 2 hours immediately after admission

DEHYDRATION
Assume that all severely malnourished children with diarrhoea have dehydration Hypovolemia can coexist with edema TREATMENT Use reduced osmolarity ORS with potassium supplements for rehydration and maintenance Amount depends on how much child wants,volume of stool loss and whether child is vomitting. Initiate feeding within 2 or 3 hours and of rehydration with f75 formula Be alert for signs of overhydration

PREVENTION Give reduced osmolarity ORS AT 510ML/KG after each watery stool Continue breastfeeding Initiate refeeding with with starter f 75 formula

ELECTROLYTES
Give

supplemental potassium at 34meq/kg/day for atleast two weeks On day 1 give give 50% magnesium sulphate ,IM once(0.3ml/kg upto 2ml).Thereafter give extra magnesium(.81.2meq/kg daily) Excess body sodium exists even though plasma sodium may be low,prepare food without adding salt

INFECTION
Multiple

infections are common Usual signs of infection like fever are often absent Majority of bloodstream infections are due to gram neg bacteria Assume serious infection and treat Hypoglycaemia and hypothermia are severe markers of infection

TREATMENT Treat with parenteral ampicillin 50mg/kg/dose 6 hourly for atleast 2 days followed by oral amoxycillin 15mg/kg 8 hourly for 5 days and gentamicin 7.5mg/kg or amikacin 15-20mg/kg IM or IV once daily for seven days If no improvement within 48 hours change to iv cefotaxime or ceftriaxone If other specific infections are identified then give appropriate antibiotics. Hand hygiene and measles vaccine should be given

MICRONUTRIENTS

Use upto twice the recommended daily allowance of vitamins and minerals On day 1 give vitaminA orally(if age>1yr give 2 lakh units,age 6-12mnths give 1lakh unit,age 0-5 mnths give 50000 units) Folic acid 1mg/d(give 5mg on day 1) Zn -2mg/kg/day,cu -.2-.3mg/kg/day,fe3mg/kg/day once child starts gaining weight after stabilization phase

INITIATE FEEDING

Start feeding as soon as possible wuth frequent small feeds If unable to take orally,initiate nasogastric feeding Total fluid recommended is 130ml/kg/day,reduce to 100ml in case of severe generalized edema Continue breastfeeding Start with f-75 starter feeds every 2 hourly F-75 contains 75 kcal/100 ml with 1 gm protein per 100 ml If persistent diarrhoea, give a serial based low lactose f75 diet If diarrhoea continues give f-75 lactose free diet.

CATCH UP GROWTH

Once appetite returns in 2-3 days, encourage higher intakes. Continue breast feeding. Make a gradual transition from f-75 to f-100 diet. F100 contains 100kcal/100ml with 2.5-3 gm protein/100ml Increase calories to 150-200kcal /kg/day,and proteins to 4-6 gm/kg/day Add complementary foods as soon as possible to prepare the child for home foods at discharge

SENSORY STIMULATION
A

cheerful,stimulating environment Age appropriate play therapy and physical activity Tender love and care

FOLLOW UP
PRIMARY FAILURE Failure to regain appetite by 4 days Failure to start losing edema by 4 days Failure to gain at least 5gm/kg/day by day 10 SECONDARY FAILURE Failure to gain atleast 5gm/kg/day for consecutive days in rehabilitation phase

PREVENTION OF MALNUTRITION
NATIONAL LEVEL;there are various programmes under NATIONAL NUTRITIONAL POLICY(NNP) INTEGRATED CHILD DEVELOPMENT SCHEME (ICDS):package of services include Supplementary nutrition,immunization,health check up and non formal pre school education,referral services,nutrition and health education

MID

DAY MEALS IN SCHOOL Programme includes a mid day meal of 450 kcal and 12 g of protein to children at primary stage. For upper primary stage ,nutritional value is fixed at 700kcal and 20 gm of protein. Adequate quantities of micronutrients like iron,folic acid and vitamin A are recommended

The expected and nursing mothers and acceptors of family planning are given one tablet containing 100 mg elementary iron and .5mg folic acid. Children are given one tablet containing 20mg elementary iron and 0.1mg of folic acid daily for 100 days.

NATIONAL NUTRITONAL ANAEMIA PROPHYLAXIS PROGRAMME

COMMUNITY LEVEL Health and nutrional education Growth monitoring Integrated health package and family planning Community based therapeutic care(CTC) FAMILY LEVEL exclusive breast feeding for first six months Proper weaning and vaccination Iatrogenic restriction of feeding in fevers and diarrhoea. Adequate time bw two pregnancies to ensure proper infant feeding and attention to child.

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