Treatment: Severe cases of PEM, especially those with complications like severe infection or dehydration require intensive care and should be admitted to a hospital for treatment. Once the condition is controlled, the treatment can be continued outside the hospital. Nutrition support is the primary consideration in such cases.
- Patients with mild to moderate dehydration can be treated by oral or nasogastric administration of fluids.
- The oral rehydration solution (NaCl 3.5 g: NaHCO3 2.5g: KCL 1.5 g and glucose 20 gm dissolved in 1 lit of water) recommended by the WHO can be safely used for correcting dehydration in PEM children.
- This amount should be given in small quantities at frequent intervals over a period of 4-6 hours.
- For patients with severe dehydration, intravenous fluid therapy is required to improve the circulation and expand plasma volume rapidly.
- About 70-100 ml of fluid can be given in the first 3-4 hours.
- As soon as urine flow is established, potassium supplements can be given orally (1-2g/kg/day).
- Diarrhoea and measles are often the immediate cause of death of PEM.
Appropriate antibiotics therapy can be given.
- Intestinal infections such as giardiasis and ascariasis must be treated with appropriate deworming agents.
Hypothermia: Marasmic children are prone to have low body temperature. If the room is cold, the child should be properly covered with a blanket. The state of shock should be treated with intravenous injection of glucose-saline or blood transfusion.
Anaemia: Severe anemia is dangerous as it can result in heart failure. If the haemoglobin falls below 5g/day, blood transfusion should be given.
- The child should be given a diet providing sufficient quantities of calories and protein in gradually increasing amounts, without provoking vomiting or diarrohoea.
- It is best to begin with a liquid formula with diluted milk.
- When this is accepted, vegetable oil can be added to increase energy content.
- Milk based formulae should be used for feeding children.
- If the child has milk intolerance, milk formulas can be substituted by buttermilk or cereal foods.
- In elder children, easily digestible solid foods like bread +milk +sugar can be given.
- A mixed cereal based diet can be given with added oil to increase energy density.
Suggested diet during convalescence
- Increasing the quantity of existing food .
- Increasing the number of meals to satisfy calorie and protein requirement.
- Addition of oil or ghee 1 to 2 tsp to increase calories without increasing bulk.
- Consumption of sugar and banana can be increased to increase calories in the diet.
- The child can be given cereal and pulse mixture in 5:1 proportion.
- If the patient can afford, milk, egg and skimmed milk can be included in the diet.
- Locally available, inexpensive and easily digestible foods should be used.
The following steps are suggested by FAO/WHO nutrition expert committee.
- Measures directed to pregnant and lactating women (education, distribution of supplements).
- Promotion of breast feeding.
- Development of low cost complementary foods. The child should be made to eat more food at frequent intervals.
- Measures to improve family diet.
- Nutrition education, promotion of correct feeding practices.
- Home economics.
- Family planning and spacing of births.
- Improving family environment.
- The child’s diet must contain protein and energy rich foods, milk, eggs, fresh fruits should be given if possible.
- Immunization schedule should be followed.
- Food fortification may help the child in meeting requirements.
Early diagnosis and treatment
- Periodic surveillance.
- Early diagnosis of any lag in growth.
- Early diagnosis and treatment of infections and diarrhea.
- Development of programmes for early rehydration of children with diarrhea.
- Development of supplementary feeding programmes during epidemics.
- Deworming of heavily infested children.
Integrated child development services (ICDS): Isolated feeding programmes will not be effective unless efforts are made simultaneously to improve the environment and control infections.
Supplementary food is therefore integrated with other health activities like
- Treatment of minor illness
- Growth monitoring
- Health education
- Supplementary feeding.
Nutrition Education: Education to improve child nutrition should stress
- The importance of breast feeding
- Timely introduction of supplements. Use of local available foods.
Feeding sufficient quantity
Maintenance of hygiene.
- Feeding balanced diets for children