MALNUTRITION (UNDER NUTRITION) IN CHILDREN : DEFINITION, CAUSES, SYMPTOMS, & MANAGEMENT
DEFINITION
- A child is said to be malnourished if weight of child is less than 80% of expected weight And/OR height of child is less than 90% of expected height.
NUTRITIONAL PARAMETERS
A. Weight for Age
- Used in IAP classification & Gomez classification.
- Used in Anganwadi growth charts.
- Decreases in both acute as well as chronic protein energy malnutrition.
- It can’t differentiate acute from chronic malnutrition.
B. Weight for Height
- Used in WHO classification & Waterlow classification.
- If decreases ⇒ Wasting ⇒ Acute protein energy malnutrition.
C. Height for Age
- Used in WHO classification & Waterlow classification.
- If decreases ⇒ Stunting ⇒ Chronic protein energy malnutrition.
Note: If both wasting & stunting in child ⇒ Acute on Chronic PEM
CLASSIFICATION
A. Indian academy of pediatric (IAP) classification
Grade | Weight for Age |
Normal | > 80% |
I | 71-80% |
II | 61-70% |
III | 51-60% |
IV | ≤ 50% |
B. WHO classification
Parameter | Moderate undernutrition | Severe undernutrition |
Weight for height | S.D. Score (Z-Score) ⇓ -2 to -3 (Wasting) | S.D. Score (Z-Score) ⇓ < -3 (Severe wasting) |
Height for Age | S.D. Score (Z-Score) ⇓ -2 to -3 (Stunting) | S.D. Score (Z-Score) ⇓ < -3 (Severe stunting) |
Edema | No | Yes |
AGE INDEPENDENT INDICES
1. Mid Upper Arm Circumference (MUAC)
- Used for 6 months to 5 years.
- Calculated at midpoint between acromion process & olecranon process.
- Normal value: 15-17 cm
If MUAC
- < 12.5 cm ⇒ Moderate PEM
- < 11.5 cm ⇒ Severe PEM
2. Shakir’s Tape
3. Bangle test (Modification of MUAC)
4. Jelliffe ratio
5. Quacker stick
6. Rao & singh index
7. Dugdale index
8. Kanawati & Mcleron index
9. Triceps skin fold thickness
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