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Nutritional deficiencies

nutritional deficiencies in pediatrics

Mariya6
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Nutritional deficiencies

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  1. Nutritional deficiencies in children………… Presented By, Mariya Antony 3rd Year BSc Nursing STCON

  2. Can you list the different nutritional deficiencies……………….???????????

  3. PROTEIN-ENERGY MALNUTRITION

  4. Protein – Energy Malnutrition • Introduction: • The term refers to a group of related disorders that include • Marasmus, • Kwashiorkor • Marasmic-kwashiorkor.

  5. 1. Marasmus This term is derived from Greek word ‘Marasmos’, which means “withering or wasting”. It occurs due to inadequate intake of proteins and calories and is characterized by emanciation.

  6. 2. Kwashiorkor • This word means “sickness of weaning “. • It involves inadequate intake of proteins and is characterized by presence of edema.

  7. Classification of pem • 1. Weight for age classification by Gomez: Weight for age = Weight of the child *100 Weight of normal child of same age

  8. If weight for age is: • >90% = Normal nutritional status • 76-90% = 1ST degree malnutrition • 61-75% = 2nd degree malnutrition • < or = 60%= 3rd degree malnutrition

  9. Waterlow’s classification on the basis of height for AGE Height for age(%)= Height of the child *100 Height of the normal child for same age

  10. If , height for age is • >95% = Normal • 90-95% = Mild malnutrition • 85-90% = Moderate malnutrition • <85% = Severe Malnutrition

  11. Classification given by Indian Academy of Pediatrics (IAP) on the basis of Weight for age. • The IAP takes weight of more than 80%of the expected weight for age, as normal . The grades of malnutrition are:

  12. 4) Wellcome Trust Classification on the Basis of Weight for Age and Presence of Edema:

  13. 5)Who classification • Stunting : It is defined as height for age being 2 standard deviation below from median height for age in NCHS reference population. • Underweight : If the weight for age is 2 standard deviation below from median weight for age , given NCHS reference population , is termed as undernutrition. • Wasting: Of the weight for age is 2 standard deviation below from median weight for height, given in NCHS reference population, it is termed as wasting.

  14. etiology • Multifactorial • Worldwide the most important cause is inadequate food intake . • Ineffective weaning secondary to ignorance, economic, and cultural factors • Gastrointestinal infections • Parasitic infections • Fat diets • Inappropriate management of food allergies • Psychiatric diseases

  15. Developed countries: • Cystic fibrosis • CKD • Childhood malignancies • Congenital heart disease • Neuromuscular diseases

  16. Preschool children are at high risk • Dependence on others for food • Increased protein and energy requirements • Immature immune systems causing greater susceptibility to infection • Exposure to non hygienic conditions

  17. Clinical manifestations COMPARISON…

  18. GUESS …WHICH IS MARASMUS..????

  19. Diagnostic evaluation • Health history • A thorough physical examination • Anthropometric assessment • PBF • Stool examination • Blood hematology and biochemistry • Blood glucose • S. albumin • Blood hb • S. electrolytes • S. cholesterol • Blood ph • Urine examination

  20. Management • Two phases: • Initial phase • Rehabilitation phase

  21. Initial phase • Treatment of complications • Correction of nutritional deficiencies • Reversal of metabolic abnormalities • Beginning of feeding

  22. 1)Treatment of complications • S – Sugar level of blood is low • H – Hypothermia • I – Infections • EL – Electrolyte • DE – Dehydration • D - Deficiency

  23. A) Hypoglycemia • 10% glucose is administered • B) Hypothermia • KMC • Warm blankets • Monitoring of rectal temperature • C)Infections • Antibiotics • Minimum visitors • Aseptic techniques

  24. D) Electrolyte disturbances • Restriction of salt intake • Potassium supplementation: 30-40meq/l • Calcium supplementation • E) Dehydration • Mild : ORS • Rehydration solution :70-100 ml/kg For period of 12 hrs

  25. Moderate to severe dehydration and shock; • Initially RL or N/2 saline : 30Ml/kg Body weight in 2 hrs, • followed by N/6 saline in 9% dextrose in a dose of 100 ml/ kg BW, in next 10 hrs. • For next 12 hrs , Same solution is at rate of 5ml/kg BW per hr. • After Dehydration: Maintenance fluid N/6 Saline in 5% dextrose at 100 ml/ kg /day , till feeding is started

  26. F) Deficiencies • Administration of vitamin A : • Infants below 6 months: 500000 IU • 6-12 months: 1 lakh IU • children above 1 yr: 2 Lakh IU • Folic acid : 5 mg on first day followed by 1 mg/ ady • Vitamin K : IM, 2.5 mg

  27. E) Initiation of feeding: • B – Beginning of feeding • E – Energy dense feeding • S – Stimulation of emotional and sensorial development • T – Transfer of home based diet before discharge

  28. Rehabilitation phase • Recovery of lost weight • Emotional and physical stimulation • Training the mother of domiciliary care • Preparation for discharge

  29. Therapeutic diet : • 175-200 kcal/kg/day • Protein: 4-5 g/kg/day • Fluid : 150ml/kg/day • Weight gain : 10-20 gm/kg/day

  30. Recovery and discharge • 6-8 weeks for recovery • Periodically follow up: 8-36 weeks after discharge

  31. prevention • Prevention at home level

  32. 2. Prevention at community level

  33. 3. At national level

  34. Vitamin deficiencyfat soluble vitamins Vitamin A

  35. forms • Vitamin A (Retinol) • Vitamin A2 • Vitamin A aldehyde • Vitamin A (retinoic acid)

  36. sources

  37. Causes for deficiency • Malnutrition • Malabsorption • Breast milk • Zinc deficiency • Iron deficiency

  38. Clinical manifestations XEROPHTAHLMIA NIGHT BLINDNESS XEROSIS CONJUNCTIVA

  39. XEROSIS CORNEA BITOT’S SPOT

  40. KERATOMALACIA GROWTH RETARDATION FOLLICULAR HYPERKERATOSIS IMPAIRED IMMUNITY

  41. Vitamin A deficiency resulting in Infections Retinoic acid binds the promoter region of specific genes Activates the transcription process Cell replication Vitamin A deficient diet will have a very limited amount of retinol

  42. Cell proliferation and replication will be suppressed Reduce number of T cells and lymphocytes Suppression of this may result in lack of immune reaction if pathogens enter the body Greater susceptibility to infections

  43. Other symptoms… • EYES • Blurred vision • Bulging eyes • Cataract, conjunctivitis • Cross eyes • Amblyopia • Glaucoma • Itching , burning and watery eyes • Retinal detachment

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