Malnutrition in children: types and handling according to conditions

Nutritional intake and nutrition of children greatly affect their health. If parents cannot fulfill their child's diet properly, there will be many health problems that can occur. One of the severe nutritional problems in Indonesia is malnutrition in children. Check out the details in the following review.

What is malnutrition in children?

Source: UNICEF

Malnutrition is a condition characterized by underweight and underweight toddlers.

Therefore, to determine the nutritional status of this one, the indicator used is a graph of body weight according to height (BW / TB).

Apart from weight and height, the circumference of the upper arm (LILA) is also included in the clinical examination of malnutrition in children and toddlers.

The condition of malnutrition in children does not happen instantaneously or briefly.

This means that children who fall into the category of malnutrition have experienced deficiencies in various nutrients for a very long period of time.

When measured using the Child Growth Chart (GPA) which refers to the WHO with various supporting indicators, children with malnutrition have their own category.

In children, it can be said to experience malnutrition when the measurement results of the weight / height indicator for nutritional status are less than 70 percent of the median value.

Simply put, value cut off z score are at less than -3 SD. Malnutrition is most often experienced by children under five when their body is chronically deficient in protein energy (KEP).

Common symptoms of malnutrition in children

According to the Management Chart for Malnourished Children from the Indonesian Ministry of Health, the following are common symptoms of malnutrition in children:

Poor nutrition without complications

Poor nutrition in children without complications has various symptoms such as:

• Looks really thin
• Experiencing edema or swelling, at least on the backs of the hands or feet
• The indicator for assessing the nutritional status of BW / PB or BW / TB is less than -3 SD
• LILA less than 11.5 cm for children aged 6-59 months
• Good appetite
• Not accompanied by medical complications

Poor nutrition with complications

Meanwhile, malnutrition in children with complications is characterized by various symptoms such as:

• Looks really thin.
• Edema or swelling of the whole body.
• The indicator for assessing the nutritional status of BW / PB or BW / TB is less than -3 SD
• LILA less than 11.5 cm for children aged 6-59 months
• Have one or more medical complications such as anorexia, severe pneumonia, severe anemia, severe dehydration, high fever, and decreased consciousness.

What are the problems of malnutrition in children?

Clinically, the problem of malnutrition in children under five is divided into several categories, namely:

1. Marasmus

Source: Healthline

Marasmus is a malnutrition condition caused by not fulfilling daily energy intake.

Whereas it should be, it is important to meet daily energy needs to support all the functions of organs, cells and body tissues.

Starting from children to adults can actually experience marasmus.

However, this condition is most often experienced by the age of children which usually occurs in developing countries.

In fact, according to data from UNICEF, lack of nutritional intake is one of the main causes of death in children under 5 years of age.

This case can kill victims up to around 3 million each year.

2. Kwashiorkor

Source: Freewaremini

Kwashiorkor is a malnutrition condition whose main cause is low protein intake. In contrast to marasmus who experience weight loss, kwashiorkor is not the case.

Children with malnutrition due to kwashiorkor are characterized by a swollen body due to fluid buildup (edema).

That is why, even though they have lost muscle mass and body fat, children with khwarshiorkor do not experience a drastic weight loss.

3. Marasmik-kwashiorkor

Source: Psychology Mania

As the name implies, marasmic-kwashiorkor is another form of malnutrition in toddlers that combines conditions and symptoms between marasmus and kwashiorkor.

This condition of malnutrition is determined by the indicator of weight of children under five based on age (BW / U) less than 60 percent of the WHO median standard.

Children who experience marasmic kwashiorkor have several main characteristics, such as:

• Very thin
• Shows signs of wasting in several parts of the body, such as loss of tissue and muscle mass, as well as bone that is immediately visible on the skin as if it is not covered with flesh.
• Experiencing fluid buildup in several parts of the body.

However, unlike kwashiorkor which has swelling in the stomach, the edema in children with both marasmus and kwashiorkor is usually not too conspicuous.

Not only that, the weight of children who are both marasmus and kwashiorkor is usually under 60 percent of normal weight at that age.

Impact of malnutrition on children

Children who do not get adequate nutrition have the potential to experience complications and long-term health problems, such as:

1. Mental and emotional health problems

According to the Children's Defense Fund, children who lack nutritional intake are at risk of suffering from psychological disorders.

For example, excessive anxiety and learning disabilities, thus requiring mental health counseling.

A study "Indian Journal of Psychiatry"2008 recorded the impact of malnutrition in children, namely:

• Lack of iron causes hyperactivity disorders
• Iodine deficiency inhibits growth
• The habit of skipping meals or a tendency to sugary foods is also associated with depression in children.

Malnutrition also has a negative impact on the development and adaptability of children in certain situations.

2. Low IQ level

According to data published in the National Health and Nutrition Examination Survey, children with malnutrition tend to skip lessons in class so that children do not go to class.

The child becomes weak, lethargic, and cannot move actively because of a lack of vitamins, minerals and other nutrients.

This is supported by data World Bank who also noted an association between poor nutrition and low IQ levels.

These children may also have difficulty making friends because of their behavior problems.

The failure of children to achieve academic and social aspects due to malnutrition, of course, has a negative impact that will continue throughout their life if they are not immediately cured.

3. Infectious diseases

Another impact of malnutrition that often occurs is the risk of infectious diseases.

Yes, children with poor nutrition will be very susceptible to infectious diseases, such as children's digestive disorders.

This is caused by a weak immune system due to inadequate nutrition.

There are many vitamins and minerals that greatly affect the work of the immune system, for example vitamin C, iron and zinc.

If the levels of these nutrients are not fulfilled, then the immune system is also bad.

Not to mention if he lacks macro nutrients such as carbohydrates and protein which are a source of energy and builders of body cells.

Lack of these nutrients will interfere with bodily functions.

4. The child is short and does not grow optimally

Stunted growth and development of your little one is the impact of malnutrition on children.

During the growth period, your little one really needs a protein substance that is relied on to build body cells and carbohydrates as the body's main energy source.

If there is no protein and other nutrients, it is not impossible that your little one's growth will be stunted and even stop prematurely.

So it is important for you to continue to monitor the health of your baby, especially if he is under five years of age.

By knowing the nutritional status, you will also find out whether your little one's development is normal or that. For that, you should always check your child to the doctor regularly.

Guidelines for handling malnutrition in children

In accordance with the management, the Indonesian Ministry of Health divides the handling of malnutrition in children into 3 phases.

1. Stabilization phase

The stabilization phase is a condition when the clinical and metabolic conditions of the child are not fully stable.

It takes about 1-2 days to recover, or even more depending on the health condition of the child.

The purpose of the stabilization phase is to restore the function of the disturbed organs and the child's digestion to return to normal.

In this phase, children will be given a special formula in the form of F 75 or its modification, with details:

• Powdered skim milk (25 g)
• Sugar (100 gr)
• Cooking oil (30 gr)
• Electrolyte solution (20 ml)
• Additional water up to 1000 ml

The stabilization phase can be done in the following ways:

Little but frequent formula feeding

The special formula was given little by little but in frequent frequency.

This method can help prevent low blood sugar levels (hypoglycemia) and does not burden the digestive tract, liver, and kidneys.

Feeding formula every day

The special formula was given for 24 hours straight. If done every 2 hours, it means that there are 12 times the gift.

If it is done every 3 hours, it means that there are 8 times the gift.

Breast milk is given after special formula milk

If the child can finish the portion given, giving a special formula can be done every 4 hours. Automatically there are 6 times the feeding.

If the child is still breastfeeding, breastfeeding can be done after the child has received a special formula.

For parents, you should pay attention to the rules for giving formulas such as:

• Better to use cups and spoons than milk bottles, even if the child is still a baby.
• Use a dropper tool for children with very weak conditions.

2. The transition phase

The transitional phase is a time when changes in feeding do not cause problems for the child's condition.

The transition phase usually lasts for 3-7 days by giving special formula milk in the form of F 100 or its modification.

The contents in formula F 100 include:

• Powdered skim milk (85 gr) 1wQ
• Sugar (50 gr)
• Cooking oil (60 gr)
• Electrolyte solution (20 ml)
• Additional water up to 1000 ml

The transition phase can be done in the following ways:

• Giving a special formula with frequent frequency and small portions. At least every 4 hours.
• The total volume administered in the first 2 days (48 hours) remains at F 75.
• Breast milk is still given after the child has finished a portion of the formula.
• If the volume of giving the special formula has been reached, this means that the child is ready to enter the rehabilitation phase.

3. The rehabilitation phase

The rehabilitation phase is a period when the child's appetite has returned to normal and can be given solid food by mouth or orally.

However, if the child is not fully able to eat orally, the administration can be done through a feeding tube (NGT).

This phase generally lasts for 2-4 weeks until the indicator of nutritional status reaches -2 SD by giving F 100.

In the transition phase, giving F 100 can be done by increasing the volume every day. This is done until the child is no longer able to finish the portion.

F 100 is the total energy the child needs to grow and is useful in feeding at a later stage.

Gradually, later the portion of the children's food menu with a dense texture can begin to be added by reducing the giving of F 100.

Guidelines for treating children with malnutrition at home

After carrying out the recommended treatment, a child can be said to be cured if the weight / body weight or weight / body weight is more than -2 SD.

Even so, proper feeding rules still have to be followed.

For parents, they can apply a child's meal schedule such as:

• Provide small and often age-appropriate meals.
• Routinely bring the child to control on time. In the first month, once a week, in the second month once every 2 weeks, and in the third to fourth months 1 time per month.

In addition, parents can also make examples of the following recipes for children:

Mung bean formula food

Materials:

• 25 gr rice flour
• Green beans or kidney beans 60 g
• Sugar 15 gr
• Cooking oil 10 gr
• Iodized salt and water to taste

How to make:

1. Boil green beans in 4 cups of boiled water for 30 minutes.
2. Once cooked, crush using a wire sieve.
3. Mix rice flour, sugar, oil, salt, and cold water as much as 50 cc (1/4 cup).
4. Put it in the boiled green beans that have been crushed, then stir until cooked over low heat.

Tofu and chicken formula food

Materials:

• Tofu 55 gr
• 40 gr rice flour
• Sugar 20 gr
• Cooking oil 15 gr
• Chicken 70 gr
• Iodized salt and water to taste

How to make:

1. Boil tofu and chicken in 500 cc of water until cooked, for about 10 minutes.
2. Once cooked, crush using a wire sieve or pulverized.
3. Add rice flour, sugar, oil, and salt, and continue cooking while stirring over low heat for 5 minutes.

To prevent malnutrition, always consult your child doctor regularly.

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