Management of severe malnutrition in children

Severe acute malnutrition is defined as a weight for height measurement which is 70% less than the median, bilateral nutritional oedema, mid upper arm circumfrence of less than 110 mm in children aged 1 to 5 years old (possibly the best and easiest measure) .
Chronic malnutrtion is defined by a height for age ration ie stunting.
Both contribute to the death of 10 million children under the age of 5 years each year. 60 million children in the world have moderate acute malnutrition 13 million with severe. 3-15% of these children will die. This problem is complicated by infection and diarrhoea
The mortality in such situations is high even in hospital 25%.
The causes are poverty, social exclusion, poor public health and in general requires economic development for all and improved public health.
As acute malnutrition deteriorates, there are adaptive processes in the body( reductive adaptations ) drawing on energy and nutrient reserves and reducing energy and nutrient demands. These however affect the bodies ability to withstand infection, eg tuberculosis and AIDs
The centres treating these children are in poor parts of the world with limited facilities.
Treatment is best on an in patient regime, in a well trained environment using WHO protocols. Realistically community care must be the end goal .
The basisi is stabililisation and rehabilitation.
The use of ready to use therapeutic food with a sufficiency of nutrients, vitamins and trace elements is so important but not always available. Oil based pastes have advantages as infection of the food which can happen with water based fods is minimised.Such treatments help move care from hospitals into the community.
Collins et al Review, Management of severe acute malnutrition in children Lancet.2006, 368, 1992-2000

Martin Eastwood
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