Malnutrition has overly been classified as an ecologically-induced condition, whereby the patients suffer as a result of famine and related food availability challenges. However, much interest is overlooked in malnutrition among children due to medical reasons, whereby prevailing physiological conditions within the child, or poor feeding practices deprive the child of important nutrients for proper growth.
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Malnutrition has for quite some time been the major killer of infants below the age of five, with data showing a prevalence of malnutrition in 16% of children in this age bracket, and the condition attributed to the death of 1 ⁄ 3 of children in that age.
Simply put, malnutrition is the low or none at all intake of food supplements that are essential to the optimal functioning of the body. However, some authors/scientists have elected to include all forms of nutritional disorders in malnutrition, covering both undernutrition and overnutrition. This article shall, however, stick to malnutrition within the context of undernutrition. Various forms of malnutrition (undernutrition) include stunting (low height for age), wasting (low weight for height), underweight (low weight for age), and deficiencies in vitamins and minerals.
Complications of Malnutrition
Malnutrition has very fatal implications among children, mostly when it is as a result of low intake of vital nutrients such as protein. The implications are physiological, medical, and cognitive.
Medical conditions of marasmus and kwashiorkor
These are immediate danger zones in malnourished children. Marasmus is characterized by muscle wasting, wrinkled skin, and metabolic underperformance such as bradycardia, hypotension and hypothermia. Kwashiorkor, on the other hand, is caused by inadequate protein intake but other nutrients may be at normal levels. It is mostly prevalent among children who have sufficient intake of carbohydrates such as corn and rice, but due to some reasons do not have adequate intake of flesh and plant protein. Kwashiorkor is uniquely characterized by edema (body fluids in the belly, feet, and hands), among other symptoms such as loss of hair and dermatitis.
Prolonged deficiency of energy
This is due to insufficient nutritional intake leads to emaciation of muscles and body fats, causing general weakness in the whole body. In children, wasting may impair the immune functioning of the body, leading to prolonged suffering from infectious illnesses, a complication that has high mortality chances.
Emaciation of muscle mass in malnutritional wasting
Wasting spreads to vital organs such as the heart, causing cardiovascular complications. With the ejection fraction down to below the average (60%) rate, some other vital organs dependent on blood circulation remain at risk. Hypotension impairs renal functioning due to a low glomerular filtration rate, with perennial deficiencies risking a renal failure of the affected.
Stunted growth is characterized by not only low physical development but also cognitive impairment due to nutritional deficiencies. Affected women, due to obstetric complications, may give birth to underweight children, passing on the malnutrition syndrome through generations. Stunting as a result of malnutrition has an irreversible implication on the height of the child, such that they may maintain the short stature even in adulthood.
Malnutrition impairs the gastro-intestinal function, causing more nutrient deficiency even during the refeeding stage, leading to the metabolic refeeding syndrome. Malnutrition has been found to cause exocrine pancreatic deficiency causing impaired intake of nutrients. Intestinal permeability is also set to reduce, leading to diarrhoea and further nutritional deficiencies.
Nutritional screening and assessment is the first step to arresting malnutrition among children. Nutritional screening tools are used to check the physical changes of the body and detect any nutritional imbalances among children so as to monitor their well-being. Common parameters for nutritional screening include clinical assessment, anthropometry, body composition methods, functional assessment and laboratory experiments.
- In clinical assessment, the patient’s medical records are monitored closely to check for any malnutrition risk-factors. Malnutrition may be caused by illnesses in the digestive tract which hamper the ingestion, digestion, and absorption of nutrients into the body. Further, clinical assessment includes physical examination of the patient’s muscles, bones, and body fats to detect wasting, stunting, and underweight malnutrition.
- Anthropometry encompasses the many forms of measurement of the body size, weight, composition, and other proportions. Body Mass Index is a formula for measuring the body weight/height ratio, to detect stunting among children. Mid-arm circumference and skinfold thickness are renown parameters of monitoring body size changes in patients.
- In body composition methods, assessment models are used to determine the proportions of the different body constituents; fat mass, fat-free mass, extracellular cell mass, body cell mass, bone mineral mass and muscle mass. Through imaging (X-ray, MRI, CT), densitometry, and bioimpedance analysis, information is acquired on the proportions of different body constituents which determine the nutritional composition of the overall body.
- Functional examination entails monitoring the strength of body muscles and the performances of respiratory and immune functions. Laboratory assessment includes the testing of protein content and other nutrients in the bloodstream. Through these parameters, the caregiver determines the nutritional health of the patient and if malnutrition is detected early then the condition is reversible.
Nutritional sufficiency in the child begins at the onset of the pregnancy all the way till the child is self-sustainable, and comprehends the concept of nutritional balance.
Healthy feeding during pregnancy
During pregnancy, the mother is advised to eat healthily, with enough fluids, and take frequent rests for optimum metabolism. Further, providers should check for nutritional illnesses like anemia and nutritional deficiency, making sure the pregnant mother has a balanced nutrition. The mother is highly advised to avoid all forms of drugs and substance abuse; quit smoking and cut alcohol intake.
Immediately after birth, the mother is advised to breastfeed the baby for six months non-stop. Medical advisory dictates that during the six months, the baby should feed on breast milk alone without complementing with other solid or liquid foods. During the six months, the baby shouldn’t have water, or infant formula as it has commonly been the case.
Breastfeeding has many advantages over other artificial methods besides just nutritional value. Through body contact with the mother, the baby develops a stronger immune system, supplementing the nutritional impact of breastmilk on the baby’s immunity. A point to note is that colostrum is meant to be fed to the baby, hence the mother should start breastfeeding within hours of the delivery to capture the highly nutritious colostrum.
Breastfeeding even during weaning
Weaning begins after six months, and even during this period the mother should not reduce breastfeeding the baby until maybe 24 months. Normally, the baby’s complementary food is specially modified from the main “adult” meals, and the mother should not think too much or observe any specialties when feeding the baby with this food.
Solving prevailing infections
There exists a plethora of infections and illnesses that can hamper the child’s nutrition just as it happens in adults. Diarrhea simply means that food ingested has not been digested as required, and is an indicator of an underlying illness. Prolonged diarrhea is one of the major causes of malnutrition among children, and the guard should be reinforced by cooperation and information sharing between the mother and healthcare providers.
Ecological factors like famine could be beyond the mother or the healthcare provider. Food security falls into another realm of governance and resource allocation. However, involved individuals can practice drought-resistant farming, or have long-term solutions for water storage so as to have a consistent supply of food. Remember the health of the mother, especially during pregnancy and breastfeeding, will utterly shape the nutritional status of the child.