Pedia Exam 2 Malnutrition Anchores 071415
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7/23/2019 Pedia Exam 2 Malnutrition Anchores 071415
1/12
UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
MALNUTRITION AND VITAMINDEFICIENCIES
Basic Assu!"ions#- Defciency state seldom occurs
alone- Anatomic lesion is an indicator o
chronic nutritional disorder- Children are more vulnerable to
nutritional insults
T$!e o% Nu"rien"s#1. Macronutrients needed in large
amounts and primarily unction assources o energy. (Carbohydrates!ats "roteins#
$. Micronutrients needed in minuteamounts and unction mainly ascoactors in many chemicalprocesses. (%itamins Minerals
&race elements#
Food Securi"$#- Access by all people at all times to
'!!)C)*+& oods in terms o,uality ,uantity and diversity oran active and healthy lie ithoutris o loss o such access.
- & diensions# Availability supply o ood Access household level
re/ecting purchasing poer asell as transer program0 oodshared e,ually ithin thehousehold
tiliation re/ect the act thateven hen the household hasaccess to ood it does notnecessarily achieve nutritionalsecurity
Food Insecuri"$#- 2imited or uncertain availability o
nutritionally ade,uate and saeoods
- Due to lac o resources to assureade,uate production importationand distribution o ood
- May lead to an3iety that ood maysoon become inade,uate
- More prevalent in developing
countries (145#- &36 mae the mother complete a 7-8day ood diary appropriate dietaryadvice and or supplementnutritional counseling
'un(er- &he uneasy sensation that results
rom lac o ood- Di9cult to defne bec concepts
di:er rom each individual- 'A6 45 o poor children ;1$yo0
$15 at ris o hunger-
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UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
B. )mbalance disproportion amongess nutrients ith or ithoutabsolute defciency o any nutrient
E!ideio)o($#$1(lobal# ;8yo- 118M undereight- 1E4M stunted- $M severe acute malnutrition
-Fighest in Asia and Arica)n the "hilippines6$11 "revalence decreased over the last$ decades but the burden remains high-8 yo6
- 7$5 undereight- 775 stunted- $.$5 overeight or height
Acu"e Ma)nu"ri"ion
- Deterioration o nutritional statusover a short period o timecharacteried by asting ornutritional edema
A. Moderate Acute Malnutrition (MAM#- GFH or G2H bet. ; -$ and ; -7- M) bet. ; -$ and ; -7. 'evere Acute Malnutriton ('AM#- MAC ;11.8cm- GFH or G2H ; -7- M) ; -7- ilateral pitting edema- Marasmic-Iashioror
Chronic Ma)nu"ri"ion
- >ccurs sloly and involvesreduction in linear groth stunting
- "roportionally normal but aresmaller and shorter than theirpeers
- Measured using the indicatorlength-or-age ;$ yo and height-or-age thereater
- Critical indo o opportunity orintervention e3ist pregnancy untilbeore 14mos o age ater hichstunting may become irreversible
CAUSES# "?)MA?J MA2+&?)&)>+
1. 2o income and purchasingpoer o amilies (totally nosource#
$. )gnorance and erroneousood habits (cultural oodpractices#
7. 'carcity o ood supply (inthe presence o naturaldisasters#
B. >verpopulation '*C>+DA?J MA2+&?)&)>+
(ith access to ood supply#1. )nectious diseases
gastroenteritis
parasitism
respiratory diseases
2oss o appetite Kfrst to maniest
$. Metabolic diseases (patientsstarved during illnesses#
diabetes
thyroid diseases
)n cases o diarrhea Kstart early eedingnever starve thepatient#
7. )atrogenic diseases starvation during
diarrhea
BATC' *+,&?A+' &*AM6 Magbitang Magalas Maluto Mercado Mi@ares esana Dacanay Contreras
With all your heart, you must trust the Lord and not your own judgment. Always let him lead you, and he will clear theroad for you to follow. Proverbs !"#$
*with dotted line: for
example, youngest will be
fed first before the others
7/23/2019 Pedia Exam 2 Malnutrition Anchores 071415
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UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
Pro"ein Ener($ Ma)nu"ri"ion PEM/
or Se0ere Acu"e Ma)nu"ri"ionSAM/- Defciencies o protein and energy- Mild moderate severe orms- roth ailure frst clinical
indication- Almost alays accompanied by
defciencieso other nutrients
Marasus In%an"i)e a"ro!h$1
Inani"ion1 Cache2ia/- severely asted- undereight- lo in both protein and calories
(balanced starvation#
34ashior5or Pro"ein
a)nu"ri"ion1 Nu"ri"iona) EdeaS$ndroe/
- Diet very lo in protein but ithcalories
- *dema is the cardinal sign
Mild, 2g/dlGross , 1.5 g/dl- !lay-paint rash or enamel
dermatoses(pathognomonic# i e3tensive poorprognosis
rading o Iashioror6radin( In0o)0een"
accd( "ose0eri"$ o%
edea
In0o)0een"as "o
se0eri"$ o%dera"oses
L Mild oth eet Discolorationor a erough
patchesLLModerate
oth eet plusloer legshands or loerarms
Multiplepatches onthe armslegs
LLL'evere
eneraliededema incboth eetlegs handsarms and ace
!laing rasin fssures
BATC' *+,&?A+' &*AM6 Magbitang Magalas Maluto Mercado Mi@ares esana Dacanay Contreras
With all your heart, you must trust the Lord and not your own judgment. Always let him lead you, and he will clear theroad for you to follow. Proverbs !"#$
7/23/2019 Pedia Exam 2 Malnutrition Anchores 071415
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UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
Pre0en"ion#1. "roper education correct aulty amily ood habits
(has to becorrected#
encourage breasteeding promote ade,uate supplementary
eeding
(tell the mother the proper time# emphasie home ood
production(additionalincome#
motivate amily planning good physical hygiene
BATC' *+,&?A+' &*AM6 Magbitang Magalas Maluto Mercado Mi@ares esana Dacanay Contreras
With all your heart, you must trust the Lord and not your own judgment. Always let him lead you, and he will clear theroad for you to follow. Proverbs !"#$
KWASHIORKOR
KWASHIORKOR
MARASMUS
Ma"erna) and 7ir"h ou"coe
N Maternal supplementation obalanced energy and protein
N Maternal iodine supplements
N Maternal deorming inpregnancy
N )ntermittent preventativetreatment or malaria
N )nsecticide treated bednetsMa"erna) and 7ir"h ou"coe
N )ron olate supplementation
N Maternal supplements omultiple micronutrients
N Maternal iodine throughiodiation o salt
N Maternal calciumsupplementation
N )nterventions to reduce tobaccoconsumption or indoor airpollution
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UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
environmental condition(handashing veryimportant#
$. )mmuniation strengthen
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UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
Adolescence (gain appetite# small mouth and nose double-
chin
adiposity in mammary regions pendulous abdomen ith hite orpurple striae disproportionately small e3ternal
genitalia (boys# &all stature advanced bone age
early puberty Acanthosis nigricans ( hypertrophic
hyperpigmentation o the sincommonly seen on the posteriornec and in sin creases# K seen atthe bac o the nec0 reduce the
eight and that ill disappear
La7ora"or$ Findin(s#&hose that evaluate C%' disease rissanddiabetes ris ("lasma lipid profles !'insulin levels FbA1c# test or sleepapnea
Pre0en"ion# breasteeding (loo lighter and
thinner than thoseinants in mil or ormula ed# delay in introduction o solid oods
(increasesugar in mil ormula#
counseling mothers to give oodonly
in response to hunger not as apacifer reorientation o amily lie toards
localorie ood promotion o physical e3ercise
Trea"en"#1. Diet therapy - caloric re,uirement depends onage
and gender
- energy balance should beemphasied$. *3ercise therapy - schools should provide specialprograms - bris al ($8 calhr#
- regular physical e3ercise atschool and at home
should be planned
- limit and monitor &% vieing time7. "sychological therapy ( ith severeor e3tremeobesity0 re,uires certain
intervention or their apnea# - emotional support - parental counseling - psychiatric reerral ther orms o therapy - asting - intestinal by-pass operation - gastric stapling (haardous should not beadvocated#
Pic54ic5ian S$ndroe- rare complication- severe cardiorespiratory distress
ith hypoventilation- CM6 polycythemia
o hypo3emiao cyanosiso somnolence
- eight reduction is e3tremelyimportant
TABLE 88-9 -- An"ici!a"or$ 6uidance# Es"a7)ishin(
'ea)"h$ Ea"in( 'a7i"s in Chi)drenDo not punish a child during mealtimes ith regard to eating.
&he emotional atmosphere o a meal is very important.
)nteractions during meals should be pleasant and happy.
Do not use oods as reards.
"arents siblings and peers should model healthy eating
tasting ne oods and eating a ell-balanced meal.
Children should be e3posed to a ide range o oods tastes
and te3tures.
!oods should be o:ered multiple times. ?epeated e3posure toinitially dislied oods ill brea don resistance.
>:ering a range o oods ith lo energy density helps children
balance energy intae.
BATC' *+,&?A+' &*AM6 Magbitang Magalas Maluto Mercado Mi@ares esana Dacanay Contreras
With all your heart, you must trust the Lord and not your own judgment. Always let him lead you, and he will clear theroad for you to follow. Proverbs !"#$
7/23/2019 Pedia Exam 2 Malnutrition Anchores 071415
7/12
UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
?estricting access to oods ill increase rather than decrease a
childTs preerence or that ood.
!orcing a child to eat a certain ood ill decrease his or her
preerence or that ood. ChildrenTs ariness o ne oods is
normal and should be e3pected.
Children tend to be more aare o satiety than adults so allo
children to respond to satiety and let that dictate servings. Do
not orce children to
7/23/2019 Pedia Exam 2 Malnutrition Anchores 071415
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UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
- cyanosis dyspnea systolicmurmur pulmonary edema andrales
A!honic 7eri-7eri- 8-E months insidious onset- hoarseness dysphonia or aphonia
Pseudoenin(ea) 7eri-7eri
- 4-1 months- apathy drosiness- signs o meningeal irritation
Dia(nosis#- t3tic test ith parenteral thiamine- increase levels o blood lactic and
pyruvic acid ater an oral glucosetest
Pre0en"ion#
?DA6 inants - .B mg older children - .P to 1.$ mg adults - 1. to 1.7 mgTrea"en"#Children - 1 mg daily or several eesAdults - 8 mg daily or several ees
Vi"ain B*Ri7o
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UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
Trea"en"#- $-1 mg )M- 1 mg ".>
Vi"ain C Scur0$/ de:cienc$
- P-$B months (pea#- improper cooing practices
C)inica) Mani%es"a"ions# painul immobile legs
(pseudoparalysis# gums bluish purple sollen depression o sternum (scorbutic
beads# irritability tachypnea )&
disturbances slo ound healing
'curvy - ormation o collagen andchondroitin sulate is impaired
deective tooth dentin loosening othe teeth hemorrhage
ollicular hypereratosis 'icca 'yndrome o '@ogren -
Verostomia Ieratocon@unctivitis sicca enlarged
salivary glandsDia(nosis#
- clinical picture- history o poor %it. C intae- V-ray fndings o long bones6
7/23/2019 Pedia Exam 2 Malnutrition Anchores 071415
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UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
- 1$ ) moderate to severericets
- Artifcial and natural lights
- )nantile &etany may occasionallyaccompany ricets seen inpatients ith steatorrhea icalcium increase ; 7-B mgdl
'$!er0i"ainosis D
- 'ymptoms develop ater 1 7months o large intae Fypotonia anore3ia
constipation polydipsiapolyuria pallor
Fypercalcemia hypercalciuria %omiting Fypertension
retinopathy Corneal cloudingT2# vitamin D and calcium intae
Me(a)o7)as"ic Aneia
- defciency o either olic acid orvitamin 1$ or both
- $ E monthsE"io)o($#
- Dietary lac- Deective Absorption- "resence o olic antagonists
(methotre3ate and anti-epileptic
drugs#- "ure goatUs milC)inica) Mani%es"a"ions#
"allor irritability !&& "ersistent respiratory inection )ntermittent ever and diarrhea
Dia(nosis#- Macrocytic type- Fypersegmentation o the
neutrophilsTrea"en"#
- !olic Acid $-8 mgday 3 $-7 ees
- Ascorbic acid $ mg
Fo)ic Acid
- !olate defciency beore becomingpregnant or during pregnancyresults in serious dysmorphic
e:ects in the etus ( neural tubedeects#
- B ug beore conception or all
child bearing age- %itamin C needed or olic acidconversion
Vi"ain E a)!ha "oco!hero) /
- !at soluble anti o3idant- )nvolve in nucleic acid metabolism- Malabsorption states- "remature inants
C)inica) Mani%es"a"ions# Creatinuria ceroid deposition in
smooth muscle
Anemia or Iashioror Femolytic anemia retinopathy inpremature inants
)ncreased platelet adhesivenessDia(nosis#
'evere1. alpha - tochopherol 6 lipid ratio o
; .4mgg and or$. erytrocyte hemolysis in
hydrogenpero3ide o more than 15 (should bedone 7 days ater an oral vit *.#Trea"en" and Pre0en"ion#
- "remature6 18-$8) per day- .E mgg o unsaturated at in thediet
- Figher dose in children ith biliaryatresia
Iron De:cienc$ Aneia IDA/
- most common orm o anemia- pea6 P-$B months
IncidenceW- 71.45 (1SS4# O 7$.B5 ($7# P
mos to 8 years- 87.5 - 1 yr old children
- 7B.45 - $ yr old children- $B.45 - 7 yr old children- 14.45 - B yr old children- 1B.5 - 8 yr old children
E"io)o($#- )nade,uate supply o iron- )nade,uate intae
BATC' *+,&?A+' &*AM6 Magbitang Magalas Maluto Mercado Mi@ares esana Dacanay Contreras
With all your heart, you must trust the Lord and not your own judgment. Always let him lead you, and he will clear theroad for you to follow. Proverbs !"#$
7/23/2019 Pedia Exam 2 Malnutrition Anchores 071415
11/12
UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
- )mpaired absorption- lood loss
C)inica) Mani%es"a"ions#
)rritabilityloss o appetite F3 o repeated respiratoryinections
"allor o sin and mucousmembranes
&achycardia systolic murmurcardiomegaly
Dia(nosis#- *3amination o peripheral blood- hypochromic microcytic- ?ed cell indices decrease MCFC
MC%- Determination o transerrin
saturation- belo 185 and serum iron ; 8mgdl
Pre0en"ion#- )nants6 1-18 mg elemental iron
dailyTrea"en" Ora) %errous SO8/#
- )nant6 P mggG P 4 ees- >lder children6 1 $ mg (total
daily iron#- &ransusions6 'everely anemic
inantchild F level B- 8 gdl orless
- &reat underlying actors
Pernicious Aneia
- due to %itamin 1$defciency- serum %itamin 1$level is belo
4 pgml
>inc De:cienc$
- Can reduce chi)d or"a)i"$- No 7ioar5er s"andard "ha" is
4ide)$ used as cu"o? "o de:ne!u7)ic hea)"h concern
- I!or"an" in (roe"h and
iuni"$- Co%ac"or in nuerouse"a7o)ic !a"h4a$s
- 6ro4"h %ai)ure1 diarrhea1d4ar:s and h$!o(onadis
- Lon( "er hi(h dose in"er%ere4i"h co!!er e"a7o)is1anore2ia1 0oi"in(
Nu"ri"iona) Assessen"- "rimary step in the evaluation o
children hose groth di:ers romthe norm
- *ssential in the management ochildren ith acute or chronicdisease
Me"hods o% Assessen" a. Assessment by history b. Clinical assessment c. se o roth Charts d. Anthropometric )ndicators e. 2aboratory assessment
Assessen" 7$ his"or$
- medical history- dietary history (motherUs child#- eight and height changes- change in psychic reaction
C)inica) Assessen"
- careul e3amination- observation- evidence o specifc defciencies
Use o% (ro4"h char"s
- roth charts are derived romlongitudinal studies o a selectedell-defned healthy populationand rom cross-sectional data onlarge numbers o children hoparticipated in national surveys
- Data are presented as "ercentile- 'erial measurements are easier to
interpret than singlemeasurements
An"hro!oe"ric Indica"ors
- eight- length- triceps sinold thicness- head circumerence- mid-upper arm circumerence (MAC#
BATC' *+,&?A+' &*AM6 Magbitang Magalas Maluto Mercado Mi@ares esana Dacanay Contreras
With all your heart, you must trust the Lord and not your own judgment. Always let him lead you, and he will clear theroad for you to follow. Proverbs !"#$
7/23/2019 Pedia Exam 2 Malnutrition Anchores 071415
12/12
UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE
S.Y. 2015 2016
Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores
La7ora"or$ assessen"s
- hematologic and protein status- determination o body composition
to defne e3cesses and defciencieso specifc nutrients
6oe@ c)assi:ca"ion
Gelcome classifcation
;a"er)o4 c)assi:ca"ion
Couni"$ Nu"ri"ion
Main 6oa)
- &o promote the nutritional health o
children- asic Core o +utrition in Community
'ea)"h Pro(ras#1. Assessment o childUs nutritional
status and needs$. +utrition Counseling7. +utrition *ducationB. &reatment o nutrition-related
conditions8. !ollo-up and reerral
Nutrition and growth of children aectsnot only their survival but also theiruality of life.!
BATC' *+,&?A+' &*AM6 Magbitang Magalas Maluto Mercado Mi@ares esana Dacanay Contreras
With all your heart, you must trust the Lord and not your own judgment. Always let him lead you, and he will clear theroad for you to follow. Proverbs !"#$
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