Pediatrics: Protein-Energy Malnutrition (PEM) - Kwashiorkor

Protein-Energy Malnutrition (PEM) in Pediatrics

Kwashiorkor

• Definition: A form of PEM characterized by edema, often seen in children who have a diet deficient in protein but rich in calories
• Causes: Inadequate protein intake, often accompanied by infections, diarrhea, or other illnesses
• Clinical features:
  • Edema (swelling) of the face, arms, and legs
  • Skin and hair changes (e.g., flaky skin, thinning hair)
  • Fatty liver
  • Anemia
  • Poor appetite
  • Weakness
• Treatment:
  • Dietary management: high-protein, high-calorie diet
  • Management of underlying infections and illnesses

Marasmus

• Definition: A form of PEM characterized by severe wasting, often seen in children who have a diet deficient in both protein and calories
• Causes: Inadequate intake of both protein and calories, often accompanied by chronic diarrhea, infections, or other illnesses
• Clinical features:
  • Severe wasting and emaciation
  • Muscle wasting
  • Loss of subcutaneous fat
  • Poor appetite
  • Weakness
  • Lethargy
• Treatment:
  • Dietary management: high-protein, high-calorie diet
  • Management of underlying infections and illnesses

Nutritional Assessment

• Methods:
  • Anthropometric measurements (e.g., weight, height, head circumference, mid-upper arm circumference)
  • Dietary history and recall
  • Physical examination (e.g., edema, muscle wasting)
  • Laboratory tests (e.g., serum albumin, hemoglobin)
• Indicators:
  • Weight-for-height (WHZ) or weight-for-age (WAZ) less than -2 standard deviations
  • Mid-upper arm circumference (MUAC) less than 13.5 cm
  • Presence of edema

Growth Monitoring

• Importance: Regular growth monitoring helps identify children at risk of PEM and track response to interventions
• Methods:
  • Regular measurement of weight, height, and head circumference
  • Plotting of growth data on growth charts
  • Identification of children who fall below the 3rd percentile or cross two percentile lines

Dietary Interventions

• Breastfeeding: Exclusive breastfeeding for the first six months, continued breastfeeding up to two years or beyond
• Complementary feeding: Introduction of nutrient-rich foods at six months, with continued breastfeeding
• Fortified foods: Use of fortified foods, such as ready-to-use therapeutic foods (RUTFs), to provide essential nutrients
• Micronutrient supplements: Provision of vitamin and mineral supplements, such as vitamin A and iron, to prevent deficiencies

Infantile Rickets

• Definition: A disease caused by vitamin D deficiency, leading to softening of bones in children
• Causes:
  • Vitamin D deficiency
  • Calcium deficiency
  • Phosphorus deficiency
• Clinical features:
  • Softening of bones (e.g., bowed legs, deformities)
  • Delayed closure of fontanelles
  • Weakness and muscle tone
  • Poor growth
• Treatment:
  • Vitamin D supplementation
  • Calcium and phosphorus supplementation
  • Exposure to sunlight (UVB) to stimulate vitamin D production

Protein-Energy Malnutrition (PEM) in Pediatrics

• Kwashiorkor is a form of PEM characterized by edema, often seen in children who have a diet deficient in protein but rich in calories.
• Causes of Kwashiorkor include inadequate protein intake, often accompanied by infections, diarrhea, or other illnesses.
• Clinical features of Kwashiorkor include edema, skin and hair changes, fatty liver, anemia, poor appetite, and weakness.
• Treatment of Kwashiorkor involves dietary management with a high-protein, high-calorie diet, and management of underlying infections and illnesses.

Marasmus

• Marasmus is a form of PEM characterized by severe wasting, often seen in children who have a diet deficient in both protein and calories.
• Causes of Marasmus include inadequate intake of both protein and calories, often accompanied by chronic diarrhea, infections, or other illnesses.
• Clinical features of Marasmus include severe wasting and emaciation, muscle wasting, loss of subcutaneous fat, poor appetite, weakness, and lethargy.
• Treatment of Marasmus involves dietary management with a high-protein, high-calorie diet, and management of underlying infections and illnesses.

Nutritional Assessment

• Methods of nutritional assessment include anthropometric measurements, dietary history and recall, physical examination, and laboratory tests.
• Indicators of PEM include weight-for-height or weight-for-age less than -2 standard deviations, mid-upper arm circumference less than 13.5 cm, and presence of edema.

Growth Monitoring

• Regular growth monitoring helps identify children at risk of PEM and track response to interventions.
• Methods of growth monitoring include regular measurement of weight, height, and head circumference, and plotting of growth data on growth charts.
• Identification of children who fall below the 3rd percentile or cross two percentile lines indicates PEM.

Dietary Interventions

• Exclusive breastfeeding is recommended for the first six months, and continued breastfeeding up to two years or beyond.
• Complementary feeding involves introduction of nutrient-rich foods at six months, with continued breastfeeding.
• Fortified foods, such as ready-to-use therapeutic foods (RUTFs), provide essential nutrients.
• Micronutrient supplements, such as vitamin A and iron, are provided to prevent deficiencies.

Infantile Rickets

• Infantile Rickets is a disease caused by vitamin D deficiency, leading to softening of bones in children.
• Causes of Infantile Rickets include vitamin D deficiency, calcium deficiency, and phosphorus deficiency.
• Clinical features of Infantile Rickets include softening of bones, delayed closure of fontanelles, weakness and muscle tone, and poor growth.
• Treatment of Infantile Rickets involves vitamin D supplementation, calcium and phosphorus supplementation, and exposure to sunlight (UVB) to stimulate vitamin D production.