Infant Malnutrition

Malnutrition is a major cause of childhood mortality and morbidity worldwide. Estimated that 7,000 deaths/day from malnutrition

There is a "chicken or egg?" type relationship between fatal infections and malnutrition in children. (e.g. poor healing of skin lesions gives Gram – bacteria an easy pathway to sepsis). Malnutrition also impairs the immune response (especially T-cells)

Growth parameters can be used to estimate growth impairment in malnourished children. 35% of the world’s children are underweight. Underweight if the child has a significant drop in weight percentile while maintaining the same length percentile. This is measured by:

Current weight / weight expected for length
If > 90% okay, if 80-90% mild, if 70-80% moderate, if <70% severe malnutrition

Types of Malnutrition

Marasmus – a clinical syndrome, wasting with minimal other changes, pure starvation

Kwashiorkor – a clinical syndrome, wasting + edema, impaired skin healing, impaired pigmentation ("flag sign" a hypopigmentation of the hair due to Cu²⁺ deficiency), hair loss, hepatomegally, anemia. Due to energy malnutrition, Fe²⁺ deficiency, folate deficiency, trace mineral deficiency, etc. Due to protein deficiency but rarely occurs outside of the hospital.

Weight Loss and Caloric Intake

change in weight = (intake – utilization) / 6000 kcal/kg

A 3 kg weight deficit is equal to 18,000 kcal deficit. Extra calories need to be added on top of a normal diet to add the missing weight back. Special tricks are used to increase the caloric density of milk without raising its osmolality.

Increasing the fat content of milk allows for Ý Ý Ý caloric density without significantly raising its osmolality. High energy formula typically contains 60% Fat, 30% CHO, and 10% protein. Treatment also requires replacement of fluid/electrolyte deficits and management of medical problems. Response to acute intervention in severe cases is potentially dramatic.

Growth failure is seen with chronic malnutrition. Lowered IQ’s observed may be a result of both the lack of proper nutrition and the environment that failed to supply adequate nutrition.

Infant malnutrition has a higher prevalence in situations of poverty, social disruption, and family deprivation. Prevention and early intervention must be integrated with health care. Public health measures that focus on the problems that lead to the inadequate diet in addition to medical treatment would help prevent children from suffering multiple episodes of malnutrition in their lives. Nutrition and Education. Example: a program in Haiti, identified malnourished children, then sent them with their mothers to a school where the moms learned how to prepare better meals and the children were fed. This way hopefully the lessons of proper nutrition would be used outside of the hospital. Cheap healthy meals can be made by mixing foodstuffs of varying protein quality to ensure all essential amino acids are in the mix.

Corn meal (amino acids - trp) + beans (amino acids + trp) + greens (source of Fe²⁺) = one darn tasty meal!