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Pediatric Nursing and child health care 92 below normal for their length is described as state of starvation. A general deficiency of protein and energy has occurred, leading to severe wasting of subcutaneous fat and muscle tissue. It often occurs between the ages of 6 months and 18 months. The marasmic child appears as a wizened old man in appearance, with loss of most fatty tissue, shriveled buttocks and emaciated limbs. Many of the signs of kwashiorkor, such as edema, skin rash and hair discoloration are absent. There is a general slowing of all body processes in response to the starvation. The marasmic child is often hungry and willing to eat when offered food. Treating Severe Malnutrition: 1. Food is the only cure for malnutrition. If a child is to be cured, he must be able to eat high protein and energy diet and his family must have enough food for him. If he does not want to eat, we have to feed him through a tube in health facilities. 2. The danger signs that show that a malnourished child needs treatment quickly are edema, apathy and not eating well. Initial Treatment • Give him a capsule of vitamin A • If necessary rehydrate him • Keep him warm, either close to his mother or well covered Pediatric Nursing and child health care 93 • If he is apathy prevent hypoglycemia by IV glucose administration • Treat skin or chest infection with an appropriate antibiotic Later treatment • Give him high protein foods by mouth later or as soon as he eats • Give him iron mixture after the first week of treatment and continue until his hemoglobin is normal • Explain the mother the importance of diet treatment and make sure that she understands that food not medicine is curing him • Caring for a malnourished child: • In addition to diagnosis of PEM there are five things we have to know • How severely malnourished is he? • His weight chart is useful • What other diseases has he? Many children with PEM have infections and some lack Vitamins Which of the six rules of good nutrition have been broken? • Breast feeding until at least 18 months • Start supplementary diet at the fourth month • Add protein foods to supplementary diet • Give children four good meals a day Pediatric Nursing and child health care 94 • Give protective foods to children over four months old (fruits, vegetables) • Sick children need more feeding Why have the rules been broken? • Poverty? • Lack of knowledge? How could his mother feed him? Prevention of malnutrition The following are some of the important approaches in prevention of malnutrition in children. • Encouraging and protecting breast-feeding • Improving weaning practices by using local foods. • Screening of infants and children at risk for malnutrition and give them • Special attention • Providing nutrition rehabilitation especially in households. • Integrate nutrition education into primary health care (PHC). • Ensure regular supervision in clinics and visiting in homes by inspection and growth monitoring E) WHO/IMCI Classification of PEM/Anemia Look and feel; • Visible severe wasting • Look for palmer pallor (some/severe) Pediatric Nursing and child health care 95 • Look for edema on both feet • Determine weight for age Table 5. Classification of malnutrition: Signs classification Severe visible wasting or Severe palmer pallor or Edema on both feet severe malnutrition/severe anemia Some palmer pallor or Very low wt. For age anemia or very low weight 7.4 Micro-nutrient/Vitamins deficiencies: Vitamins are groups of organic substances not synthesized by the human body but essential as catalysts of cellular metabolism and thus for normal growth. Since the body doe not manufacture vitamins small amounts must be included in the diet. Some are soluble in fat and are ingested in dietary fat (vitamin A, D, E and K), and some are water soluble (Vitamin B complex and Vitamin C). Vitamins; Functions and Deficiency 1. Vitamin A Normal growth, normal vision, normal reproduction Maintenance of epithelial cell structure and function Immunity to infection Pediatric Nursing and child health care 96 Deficiencies results in: • xerophthalmia, (night blindness, conjunctiva dryness, Bitot spots, Keratomalacia, and even eyeball perforation and
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