How to Diagnose and Treat Malnutrition in Children?

How to Diagnose and Treat Malnutrition in children?

There are three commonly used methods to diagnose malnutrition in children: stunted growth (height below the expected level for their age), underweight (weight below the expected level for their age), and wasting (weight lower than expected for their height, or a low body mass index). These assessment methods for childhood malnutrition are interrelated. According to a study by UNICEF, children with stunted growth due to malnutrition account for only 9% of children with stunted growth, underweight, and wasting. While measuring growth and development is essential in determining childhood malnutrition, relying solely on height and weight measurements often leads to underdiagnosis of severe malnutrition and underestimation of its prevalence.

Grading of malnutrition:

Grade I Malnutrition: Normal mental state. Weight is 15% to 25% below normal, subcutaneous fat thickness is 0.8 to 0.4 centimeters, dry skin, and height is not affected.

Grade II Malnutrition: Low spirits, irritability, reduced muscle tone, and muscle relaxation. Weight is 25% to 40% below normal, subcutaneous fat thickness is less than 0.4 centimeters, pale and dry skin, dull hair, and reduced height compared to normal.

Grade III Malnutrition: Lethargy, alternating between drowsiness and irritability, delayed intellectual development, muscle atrophy, low muscle tone. Weight is more than 40% below normal, height is significantly below normal, subcutaneous fat disappears, forehead wrinkles appear, and the child may have a haggard appearance. Common symptoms include low body temperature, slow pulse, loss of appetite, and constipation, and severe cases may lead to malnutrition-related edema.

Treatment of childhood malnutrition: Due to the different causes, conditions, and courses of malnutrition, treatment should focus on identifying and eliminating the underlying causes, with dietary adjustments as the primary comprehensive therapy. Children with malnutrition often have poor gastrointestinal function, leading to loss of appetite, diarrhea, or constipation, exacerbating malnutrition in a vicious cycle.

Principles of dietary therapy:

1. Gradual progression: Based on the child's ability to accept food, gradually increase nutritional intake without rushing. For children with poor digestion, the adjustment should be slow, and it may take about half a month to reach the dietary intake level of children of the same age.

2. Reasonable food selection: According to the child's nutritional needs, supplement what is lacking and provide targeted supplementation. For example, children with insufficient energy should consume grains, dairy products (including yogurt), fish, meat, poultry, eggs, and soy products to provide adequate energy and rich, high-quality proteins, minerals, and trace elements.

3. Medication intervention to regulate diet and improve the child's digestion and appetite. For instance, supplementing with iron, zinc, and multiple nutrient supplements as needed.

If a child's poor appetite persists despite dietary adjustments, or if the child continues to lose weight, it is important to seek medical attention, identify the underlying cause, and provide appropriate treatment.

The World Health Organization and UNICEF have proposed treatment measures for childhood malnutrition, including providing fortified milk formula containing the lacking micronutrients or directly supplementing the required nutrients as therapeutic food and nutritional supplements for severely malnourished children. In practice, this approach has been proven effective in promoting weight gain in children during emergencies.

In clinical practice, the author's experience shows that children with malnutrition complicated by infections should receive antibiotic treatment to control the infection before adjusting the diet and providing nutritional supplementation to achieve good results. For severely malnourished children with infection-related shock, respiratory failure, or bradycardia, prompt examination of the internal environment of the body and appropriate symptomatic treatment are required. Malnourished children with anemia or rickets should have both anemia and rickets treated simultaneously. Children with malnutrition and diarrhea often suffer from water and electrolyte imbalances and hypoalbuminemia. When administering fluids, accurate calculations of various electrolyte supplements based on blood electrolyte test results are necessary. The general principle is to provide isotonic solutions and both crystalloid and colloid solutions to facilitate recovery from diarrhea. The author has also encountered many cases of malnourished children with diarrhea from rural areas. Despite their good appetite, due to parental misinformation, their diet was still restricted for a long time, worsening the diarrhea. In these cases, the author reversed the treatment strategy, providing the children with high-protein, high-calorie diets supplemented with supportive therapy, which quickly resolved the diarrhea. Malnourished infants who frequently vomit or aspirate milk may develop aspiration pneumonia and complications such as hyponatremia and hypocalcemia, leading to cyanosis and respiratory pauses. In such cases, blood tests for electrolytes should be performed promptly, and appropriate corrective measures should be taken to avoid life-threatening situations. Severely malnourished children with dehydration require hospitalization. Such children often have compromised cardiac and renal function. During fluid, blood, or plasma transfusions, the infusion rate may be slightly faster initially, but once blood volume is substantially replenished, the infusion rate should be reduced to avoid heart failure, and vigilance must be heightened.