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Protein Calorie Malnutrition

It can be divided into two types
(1) Kwashiorkar
(2) Marasmus

There are two extreme of the disease and marasmus is more common in India.

Prevalence of Kwashiorkar is between 2 and 3 years except in Delhi and Bombay. Where peak is between 3 and 4 years. Clinical oedema was present in 1 % of all age groups.

Muscle wasting in Marasmus was seen 2%. Peak prevalance was observed between 1-11/2 years in almost all the regions.

Marasmus is seen in children which are poorly nourished, which can be due to unsufficient breast milk, diluted goat milk or late introduction of solidfoods. Repeated infections make the conditions worse.

Marasmic child has very little or no subcutaneous fat. Head is large, hair growth is very low, weight is below 60% of expected weight. He may have pigmented skin.

In extreme cases child looses interest in his environment and he is immobile, Moderate anaemia along with other deficiencies is also seen. Although in early stages, appetite is good but on later stages loss of appetite is observed.

"Kwashiorkar" an African words means 'A Syndrome of one and two i.e. a condition which arises when the child is displaced by another child. Weight is less than 60% of expected weight but sudden gain of weight is seen depending upon degree of Oedema present. Main features are moonface, apathy, scanty lustreless hair and oedema. Pigmented skin often shows peeling and even Ulceration.

It is seen that on same diet and same household environment, one child develops Kwashiorkar where as other develop Marasmus.

Lack of adequate calories is seen in both the conditions. Other deficiencies are also seen accompanied with protein and colories deficiency.

It is very important to diagnose it at early stage of Protein-Calorie Malnutrition rather than allowing the full blow picture.

Most important is the adequate diet and not vitamin pills or injections. Feeding should be made interesting for him to arouse his appetite.

And starting from small amounts they should be increased gradually reaching normal requirements within 2-3 weeks using household diet mainly. Child should not allow to suck empty breast and in this condition breast feeding should be stopped replacing it by some other animals milk; even 200 ml is enough. Parents must be trained to get full value of their money spent on food.

Small frequent feeds should be advised. Specially milk should not be offered in large doses which may result in diarrhoea due to lactose deficiency of milk. If child is too young then rice conjee can be added to milk or very thin wheat porridge can be given to decrease the lactose load.

Recovery can be seen by the changing face expressions, his smiles and brightness of eyes.

Severely malnurished children are prone to develop low body temperature, which is harmful and may even result in death. They should be adequately clothed and kept warm. All associating deficiencies and infections should be adequately treated.

The management can be done at home in rehabilitation centre and in severe case - in a hospital.