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Pediatrics MALNUTRITION - Dra. Garcia's Lecture: Primum Non Nocere
Pediatrics MALNUTRITION - Dra. Garcia's Lecture: Primum Non Nocere
Cardiovascular
Polymicrobial Infection in NOMA o Bradycardia, hypotension, reduces
Fusobacterium necrophorum cardiac output, small vessel
Prevotella intermedia vasculopathy
Neurologic
Treatment of Noma: o Global developmental delay, loss of
Local wound care knee and ankle reflexes, impaired
Pencillin memory
Metronidazole Hematologic
Therapy for the underlying predisposing o Pallor, petechiae, bleeding diathesis
condition Behaviour
o Lethargic, apathetic, irritable on
CLINICAL SIGNS OF MALNUTRITION handling
Face
o Moon face (kwashiorkor), simian PATHOPHYSIOLOGY OF SEVERE PROTEIN CALORIE
facies (marasmus) MALNUTRITION
Eye
o Dry eyes, pale conjunctiva, bitot Edematous or Non-edematous Malnutrition??
spots (vitamin A), periorbital edema Variability among infants in nutrient
Mouth requirements and in body composition at the
o Angular stomatitis, cheilitis, glossitis, time the dietary deficit is incurred.
spongy bleeding gums (vitamin C), Giving excess carbohydrate to a child with
parotid enlargement non-edematous malnutrition reverses the
Teeth adaptive responses to low protein intake
o Enamel mottling, delayed eruption mobilization of body protein source
Hair albumin synthesis decreases
o Dull, sparse, brittle hair, hypoalbuminemia with edema
hypopigmentation, flag sign Fatty liver: due to lipogenesis from the excess
(alternating bands of light and carbohydrate intake and reduced
normal color), broomstick eyelashes, apolipoprotein synthesis
alopecia Other causes if edematous malnutrition:
Skin aflatoxin poisoning, diarrhea, impaired renal
o Loose wrinkled (marasmus), shiny function and decreased Na+/K+ ATPase
and edematous (kwashiorkor), dry, activity
follicular hyperkeratosis, patchy Free radical damage may also be an important
hyper and hypopigmentation (crazy factor in the development of edematous
paving or flaky paint dermatosis), malnutrition. (low plasma methionine, a
erosions, poor wound healing dietary precursors of cysteine, which is
Nails needed for synthesis of the major antioxidant
o Koilonychia (spoon nails), thin and factor, GLUTATHIONE.
soft nail plates, fissures or ridges
Musculature MANAGEMENT OF SEVERE MALNUTRITION
o Muscle wasting particularly buttocks Initial Phase (1-7 days) – stabilization phase
and thighs, Chvostek and Trosseau o dehydration is corrected
sign (hypocalcemia) o Treat or prevent hypoglycaemia and
Skeletal hypothermia
o Deformities, usually as a result of o Correct electrolyte imbalance
calcium, Viatmin D or Vitamin C o Treat bacterial or parasitic infection
deficiencies o Oral rehydration therapy is preferred
Abdomen o Oral feedings stated with specialized
o Distended, hepatomegaly with fatty high calorie formula.
liver, ascites may be present
Chronic partial sleep loss can increase risk for ADINOPECTIN (a peptide with anti-
weight gain and obesity inflammatory properties) – occurs in reduced
EFFECTS OF SLEEP DEBT levels in obese patients
Results in decreased glucose tolerance and
insulin sensitivity related to alterations in Low Adinopectin Levels Correlate with:
glucocorticoids and sympathetic activity Elevated levels of free fatty acids
Release of orexins (peptides synthesized in Elevated levels of plasma triglycerides
the lateral hypothalamus) increase feeding, High BMI
arousal, sympathetic activity, and or Adipocytes secrete peptides and cytokines
neuropeptide Y activity. into the circulation
Proinflammatory peptides such as interleukin-
Role of Genetics in Obesity: 6 and TNF- occur in high levels in obese
Rare single-gene disorders resulting in human patients.
obesity are known, including FTO (Fat Mass IL-6 stimulates production if C-Reactive
and Obesity) and INSIG2 (insulin-induced gene Protein
2) mutations as well as leptin deficiency and CRP is a marker of inflammation and might
pro-opiomelanocortin deficiency link obesity, coronary disease and subclinical
Prader-Willi Syndrome inflammation
Remove televisions from children’s bedroom; Ban advertising of fast foods directed at pre-
restrict times for television viewing and video school children, and restricts advertising to
games. school-aged children.
SCHOOLS
ESTABLISHING HEALTHY HABITS IN CHILDREN
Eliminate fundraisers with cookie and candy
Do not punish a child during mealtimes with
sales.
regard to eating. Interactions during meals
Review the contents of vending machines and
should be pleasant and happy.
replace with healthier choices.
Do not use food as a reward.
Install water fountains.
Parents, siblings and peers should model
Educate teachers, especially physical
healthy eating, tasting new foods, and eating
education and science faculty, about basic
a well-balanced meal.
nutrition and benefits of physical activity.
Children should be exposed to a wide range of
HEALTH CARE PROVIDERS food, tastes, and textures.
Food should be offered multiple times.
Explain the biologic and genetic contribution Repeated exposure to initially disliked foods
to obesity. will break down resistance.
Give age-appropriate expectations for body Forcing a child to eat certain food will
weight in children. decrease his or her preference for that food.
Work toward classifying obesity as a disease Do not force children to “clean their plate”.
to promote recognition, reimbursement for
care, and willingness and ability to provide SUMMARY
treatment.
Malnutrition
INDUSTRY Criteria used in defining malnutrition
Micronutrient deficiencies
Mandate age-appropriate nutrition labelling Protein Energy Malnutrition (Marasmus and
for products aimed at children (ex. Red/Green Kwashiorkor)
light food, with portion sizes.) Overweight and Obesity
Encourage marketing of interactive video
games in which children must exercise in
order to play.
Use celebrity advertising directed at children
for healthful foods to promote breakfast and
regular meals.