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What defines 'Underweight' in terms of standard deviations?
What defines 'Underweight' in terms of standard deviations?
Measurements that fall below 2 standard deviations under the normal weight for age.
Explain what constitutes 'Stunting' and its significance.
Explain what constitutes 'Stunting' and its significance.
Stunting is defined as measurements falling below 2 standard deviations below height for age, indicating chronic malnutrition.
Identify and describe one micronutrient deficiency associated with fatigue.
Identify and describe one micronutrient deficiency associated with fatigue.
Iron deficiency, leading to fatigue, anemia, and decreased cognitive function.
What are the clinical features of 'Kwashiorkor'?
What are the clinical features of 'Kwashiorkor'?
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How does 'Marasmus' differ from 'Kwashiorkor'?
How does 'Marasmus' differ from 'Kwashiorkor'?
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What causes 'Protein Energy Malnutrition' (PEM) in underdeveloped areas?
What causes 'Protein Energy Malnutrition' (PEM) in underdeveloped areas?
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Describe the term 'Micronutrient Deficiencies' and provide two examples.
Describe the term 'Micronutrient Deficiencies' and provide two examples.
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What are the consequences of Vitamin D deficiency in children?
What are the consequences of Vitamin D deficiency in children?
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What is 'Marasmic kwashiorkor' and how does it present?
What is 'Marasmic kwashiorkor' and how does it present?
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Outline the impact of delayed introduction of complementary foods on child nutrition.
Outline the impact of delayed introduction of complementary foods on child nutrition.
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What age range typically sees the manifestation of organic diseases like CKD and CHD?
What age range typically sees the manifestation of organic diseases like CKD and CHD?
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List three components involved in the nutritional assessment of a child.
List three components involved in the nutritional assessment of a child.
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What physical examination signs are associated with Marasmus?
What physical examination signs are associated with Marasmus?
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What nutritional history is crucial when assessing infants for malnutrition?
What nutritional history is crucial when assessing infants for malnutrition?
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What is a hallmark symptom of Kwashiorkor?
What is a hallmark symptom of Kwashiorkor?
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Describe a common skin manifestation in Kwashiorkor.
Describe a common skin manifestation in Kwashiorkor.
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What is the initial step in the management of a severely malnourished child?
What is the initial step in the management of a severely malnourished child?
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What laboratory test is prioritized for a child suspected of malnutrition?
What laboratory test is prioritized for a child suspected of malnutrition?
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In anthropometric measurements, what is a key indicator for children under 2 years?
In anthropometric measurements, what is a key indicator for children under 2 years?
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What does a waist-to-hip ratio (WHR) indicate?
What does a waist-to-hip ratio (WHR) indicate?
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What physical sign can indicate dehydration in a malnourished child?
What physical sign can indicate dehydration in a malnourished child?
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How can muscle wasting be identified in a physical examination?
How can muscle wasting be identified in a physical examination?
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What general principle should be followed during the acute phase of malnutrition treatment?
What general principle should be followed during the acute phase of malnutrition treatment?
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What might be a noticeable hair characteristic in a child with Kwashiorkor?
What might be a noticeable hair characteristic in a child with Kwashiorkor?
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What role does social history play in assessing a malnourished child?
What role does social history play in assessing a malnourished child?
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Study Notes
Failure to Thrive
- Failure to thrive is a condition where a child's growth is significantly slower than expected for their age.
- It's categorized by several measurements, including stunting, wasting, and underweight.
Stature-for-age percentiles
- Growth charts display the expected height for different age groups and percentiles (e.g., 5th, 25th, 50th, 75th, 90th, 95th, 97th).
- These charts help identify children whose development falls significantly below or above averages.
- Data is displayed for both girls and boys, ages 2 to 20 years.
Protein Energy Malnutrition (PEM)
- PEM encompasses a range of conditions caused by inadequate protein and energy intake, often seen in developing countries.
- Underweight: A measurement below 2 standard deviations from the normal weight for a given age.
- Stunting: A measurement below 2 standard deviations below height for age.
- Wasting: A measure below 2 standard deviations below weight for height.
- Understanding these definitions helps differentiate the types of malnutrition
- PEM frequently results in multiple nutritional deficiencies.
Micronutrient Deficiencies
- Iron: Anemia, fatigue, poor cognitive function, glossitis (inflammation of the tongue), and nail changes are all symptoms.
- Iodine: Goiter (enlarged thyroid gland), developmental delays, and intellectual disability are signs.
- Vitamin D: Poor growth, rickets, and hypocalcemia (low calcium levels).
- Vitamin A: Night blindness, xerophthalmia (eye dryness), poor growth, and hair abnormalities are some signs.
- Folate: Glossitis and anemia are prominent symptoms.
- Understanding these micronutrient deficiencies is critical in managing malnutrition.
Clinical Forms of PEM
- Marasmus: Severe wasting(loss of muscle mass), with weight for age below 60% of the average.
- Kwashiorkor: Severe malnutrition with edema, weight for age between 60-80% of the average.
- These are significant distinctions in the clinical presentation of malnutrition.
Causes of PEM
- Early weaning (discontinuation of breastfeeding before the optimal age), delayed introduction of complementary foods.
- Low protein diets, severe/frequent infections, and organic diseases (e.g., kidney diseases).
- Knowledge of these causes can be instrumental in preventative measures.
Nutritional Assessment
- Medical and dietary history: Understand past illnesses and current nutritional intake (breastfeeding, formula, etc.)
- Anthropometric evaluation and physical examination: Assess height, weight, body mass index (BMI), and other vital signs.
- Laboratory measurements: Analyzing blood, urine, etc., for essential components.
Medical and Dietary History
- Obtain a detailed medical history, including acute and chronic illnesses, preexisting nutrient deficiencies, social history (poverty, violence, etc.), and current dietary habits.
- Evaluate the patient's quantity and quality of current intake, breast feeding patterns in infants, formula preparation, volume consumed, and feeding techniques.
Marasmus
- Characterized by significant weight loss over months or years.
- Child may appear severely ill, apathetic, irritable, hungry, and have sparse, brittle hair.
- Physical examination may reveal growth retardation, underweight status, corneal opacity, and other symptoms.
Marasmus—Physical Examination
- Poor skin turgor is typical.
- Nails become thin, frail, and fissured.
- Muscle wasting is apparent.
- Abdominal distention, and subcutaneous tissue loss are key signs.
- Recal prolapse, hypothermia, hypotension, and bradycardia are vital signs observed.
- Anthropometry typically reveals wasting and stunting, with weight and height significantly below the average expected.
Kwashiorkor
- Significant weight loss over weeks to months.
- May seem well-nourished, yet apathetic, irritable, and anorexic.
- Characterized by moon face, pitting edema, and overall fatness.
- Physical examination reveals changes in hair (flag sign, hypochromotrichia, easily plucked, sparseness, silkiness, and fragility).
- Additional signs include thin upper arms, edema, and often mucosal thinning.
Kwashiorkor—Physical Examination
- Skin changes, such as flaking, pellagra-like skin, skin fissures, and/or ulcerations, are noted.
- Mucosal thinning, mild anemia are evident.
- Fragile/thin nails, hepatomegaly (enlarged liver), and symptoms suggestive of hypothermia and hypotension may also be present.
- Notably, anthropometry frequently reveals underweight, though with an occasional fat appearance.
History and Physical Examination Followed by Investigations
- First-line investigations: Complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), urine analysis, culture, creatinine (Cr), and blood glucose levels.
- Second-line investigations: Serum amino acids, organic acid testing, liver function tests (LFTs), Mantoux test, abdomen, chest, head ultrasound, and electrocardiogram (ECG) assessments.
- Other investigations may be needed depending on specific clinical situation.
Assessments of Severely Malnourished Children
- Priority areas include dehydration, infection, and the intake of food and drinks.
General Treatment Principles
- Initial acute phase involves correcting shock, dehydration, and other life-threatening conditions like hypoglycemia and hypothermia.
- Electrolyte imbalances need prompt attention.
- Micronutrient deficiencies are addressed in consultation with proper investigations
- Feeding is carefully reintroduced gradually
Stabilization Phase
- Treatment focuses on addressing shock, dehydration, hypoglycemia, and hypothermia
- Crucial in establishing a stable condition for subsequent stages
- Includes appropriate IV fluids, oral rehydration salts, micronutrients, and electrolytes, and treating accompanying infections.
Rehabilitation Phase
- The rehabilitation phase involves weight gain of at least 10 grams per kilogram of body weight per day initially to avoid cardiac failure.
- Treatment should focus on slowly increasing the energy & protein intake.
- Aiming for a height-to-weight ratio of 90% of the average is the recovery benchmark
Nutritional Rehabilitation Phenomena
- Pseudo-tumor cerebri: A self-limiting condition with vomiting as a key symptom indicating increased intracranial pressure, requiring careful medical attention
- Nutritional recovery syndrome: Signs like hirsutism, gynecomastia, and abdominal distension indicate hormone recovery following a period of malnutrition.
- Encephalitis-like syndrome: A severe form requiring significant medical attention, which might be fatal.
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Description
Explore the factors contributing to failure to thrive in children, including growth measurements like stunting, wasting, and underweight. Understand the importance of stature-for-age percentiles and the impact of protein energy malnutrition. This quiz highlights methods to assess children's growth and development effectively.
