Topic: Protein- energy malnutrition
Question: List the diagnostic criteria for severe malnutrition according to WHO classification in under five children. Discuss the home/community based management of children with moderate malnutrition.
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WHO diagnostic criteria for severe acute malnutrition in children under 5 years:
Severe acute malnutrition is defined by very low weight-for-height/length (Z- score below -3 SD of the median WHO child growth standards), or a mid-upper arm circumference < 115 mm, or by the presence of nutritional oedema. Severe Acute Malnutrition is both a medical and social disorder.
1. Severe wasting: Weight-for-height < -3 SD of WHO growth standards. OR Mid-upper arm circumference (MUAC) < 115 mm.
2. Nutritional edema: Bilateral pitting edema of feet.
3. Severe underweight: Weight-for-age < -3 SD of WHO growth standards.
4. Clinical signs: Poor appetite, poor weight gain, listlessness, deep depression of eyes, thinning of hair, poor skin and hair pigmentation.
Management of moderate acute malnutrition in community settings:
1. Dietary management: Provide energy dense, high-protein diet. Examples:
– Khichdi with oil, nuts and milk
– Egg, fish, poultry or meat 2-3 times/week
– Frequent milk feeds: 100-200 ml 3-4 times/day
– Add oil, ghee or butter to meals
– Nutritious snacks: peanut butter sandwich, mashed avocado, etc.
2. Nutrition counseling: Educate caregivers on causes of malnutrition, appropriate diet, hygiene, etc. Make follow-up home visits.
3. Growth monitoring: Weekly or biweekly weight and MUAC monitoring. Watch for deterioration into severe malnutrition.
4. Appetite stimulation: Provide sensory stimulation. Feed slowly and patiently in a quiet, distraction-free environment.
5. Treatment of infections or other illnesses: As appropriate. This will improve appetite and nutrient absorption.
6. Micronutrient supplementation: Calcium, iron, zinc, vitamin A and D as per IMNCI guidelines based on deficiency in the region.
7. Locally made energy dense foods: Promote the use of available family foods that can enrich the diet. Ex: coconut milk, palm oil, pumpkin, sweet potatoes.
The key goals are to provide additional energy, protein and micronutrients to support growth; Educate caretakers to continue wholesome feeding practices long-term; Monitor and catch any deterioration to severe malnutrition early. Moderate malnutrition can often be managed at home with nutritious food, community support and regular growth monitoring.
