Kwashiorkor: Oedema of face (moon face) and lower limbs, failure to thrive, anorexia, diahorroea, apathy, dermatosis (hypo & hyper pigmentation), flaky paint dermatitis, sparse, soft and thin hair, angular stomatitis, cheilosis and anaemia. (Figure)
Marasmus: Failure to thrive, irritability, frightfulness, apathy, diarrhoea, anorexia, dehydration
Child is shrunk (little or no subcutaneous fat)
Watery diarrhoea and acid stools
Muscles are weak and atrophic
Marasmic kwashiorkor: Mixture of some features of both marasmus and kwashiorkor.
Nutritional dwarfing:Some children adapt to prolonged insufficiency of food lacking in energy and protein leading a marked retardation of growth. Weight and height are both reduced.
Under weight child: These children are smaller than their genetic potential which is of greater importance as they are at risk of gastroenteritis, respiratory and other infections which can precipitate to malnutrition.
Treatment Treatment strategy can be divided into three stages. Resolving life threatening conditions Restoring nutritional status without disrupting homeostasis. Children below 2 years require 200k cal/kg body weight, whereas children older than 2 years require energy 150 – 175k cal/kg body weight Protein ---- 5g/kg body weight Fats ------ 40% of total calories Use locally available staple foods. Inexpensive, easily digestible and all 5 food groups to be included which are minimum of 100ml/milk with
Cereal: Pulse – 5:1 (evenly distributed throughout the day).
Number of feedings and quantity of food should be increased.
Concentrated sources of energy should be added like oil, butter, ghee etc.
Ensuring nutritional rehabilitation by establishing