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Malnutrition (Under Nutrition) in Children : Causes, Symptoms, & Treatment

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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