Session 5

Malnutrition and Anemia

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 Learning Objectives
By the end of this session, the students will be able to:

(1) define malnutrition and anemia;

(2) differentiate the forms of malnutrition and anemia;
(3) demonstrate proper weighing and use of growth
chart;
(4) recognize the signs of malnutrition and anemia
(5) assess and classify; and
(6) demonstrate how to counsel mothers on proper
2 nutrition
 Malnutrition

a pathological state secondary to relative or

absolute deficiency or excess of one or more
essential nutrients
 it can also develop in children with diet
lacking in the recommended amounts of
essential vitamins and minerals( iron)

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 Major Causes of Malnutrition

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 Forms of Malnutrition

(1) Protein Energy Malnutrition is a deficiency

of calories and or protein in a child’s diet
Forms of PEM
(1) marasmus
(2) kwashiorkor
PEM is present if:
– The child is severely wasted
– The child develop edema
– The child do not grow well and become
5 stunted
 Forms of Malnutrition

(2) Nutrient Deficiencies

- anemia (lack of iron)

- Vitamin A deficiency

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 Kwashiorkor and Marasmus

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 Marasmus

 occur at all ages, more common at 0-2

years old
 child is not getting enough energy from his
regular diet
 balanced starvation
 result of unsuccessful breast feeding or
insufficient breast supply
 severely wasted

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 Marasmus

 gross loss of subcutaneous fat; “ all skin and

bone; “ loose skin folds in buttocks
 potbelly and winged scapulae
 poor appetite
 apathetic

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 Marasmus

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 Kwashiorkor

* usually 1 -3 years old

* results from a low protein diet
* presence of bipedal is a cardinal sign
Common signs :
- Hair changes – sparse
- straight
- dyspigmented (light brown, reddish brown
blonde
- flag sign (light and dark bands in hair)
- Diffuse depigmentation – flaky paint or enamel
dermatoses
- Puffy and moon faced
- Anemia
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 Kwashiorkor

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 Malnutrition and Anemia
For ALL sick children ask the mother about the child’s difficult breathing, diarrhoea, fever, ear
problem and then
CHECK FOR MALNUTRITION AND ANAEMIA.

THEN CHECK FOR MALNUTRITION AND ANAEMIA

LOOK AND FEEL:
Classify
Look for visible severe wasting.
NUTRITIONAL
Look for palmar pallor. Is it: Severe palmar pallor? STATUS
Some palmar pallor?
Look for oedema of both feet.
Determine weight for age.

CLASSIFY the child’s illness using the colour-coded-classification table for malnutrition and
anemia

Then CHECK immunization status and for other problems.

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 Malnutrition and Anemia

CHECK FOR MALNUTRITION

AND ANEMIA
LOOK AND FEEL:
Look for visible severe
wasting
Look for palmar pallor. Is it:
- severe palmar pallor?
- some palmar pallor?
Look for edema of both feet
Determine weight for age
CLASSIFY NUTRITIONAL
14 STATUS
 How to check for malnutrition and
anemia

 Look for visible signs of wasting

 Look for palmar pallor
 Look and feel for edema of both feet
 Determine weight for age

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 How to determine weight for age

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 How to classify nutritional status

 SevereMalnutrition OR Severe Anemia

 Anemia OR Very Low Weight
 No Anemia AND Not Very Low Weight

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 CLASSIFICATION TABLE FOR MALNUTRITION AND ANEMIA
IDENTIFY TREATMENT
SIGNS CLASSIFY AS (Urgent pre-referral treatments are in bold print.)
Visible severe wasting Give Vitamin A.
or SEVERE Refer URGENTLY to hospital.
Severe palmar pallor MALNUTRITION OR
or SEVERE ANAEMIA
Oedema of both feet.

Some palmar pallor or Assess the

Very low weight for feeding according to the FOOD box on the COUNSEL
age. THE MOTHER chart.
— If feeding problem, follow-up in 5 days.
ANAEMIA OR VERY If pallor:
LOW WEIGHT — Give iron.
— Give oral antimalarial if high malaria risk.
— Give mebendazole if child is 2 years or older and
has not had a dose in the previous 6 months.
Advise mother when to return immediately.
If pallor, follow-up in 14 days.

If very low weight for age, follow-up in 30 days.

Not very low weight for Ifchild is less than 2 years old, assess the
age and no other signs NO ANAEMIA AND feeding and counsel the mother on feeding
or malnutrition. NOT VERY LOW according to the FOOD box on the COUNSEL THE
WEIGHT MOTHER chart.
— If feeding problem, follow-up in 5 days.
18 Advise mother when to return immediately.
 Severely malnourished child

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 Severely malnourished children

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 Anemia

A reduced number of
red blood cells

or

A reduced amount of
hemoglobin in each
red blood cell

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 Conditions Predisposing to Anemia

 infections

 hookworm and whipworm infections

 malaria

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 How to check for Anemia

(1) Look for palmar pallor

(2) Hold the child’s palm open by grasping it

gently form the side.

DO NOT STRETCH THE FINGERS BACKWARDS

This may cause pallor by blocking the blood
supply.
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 How to check for anemia

(3) Compare the color of the child’s palm with

your own palm and with the palm of other
children.

Severe palmar pallor - very pale or white

Some palmar pallor - pale

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 How to classify Anemia

Severe anemia
severe palmar pallor

Some anemia
some palmar pallor

No Anemia

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 Children with Anemia and Malnutrition

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 How to identify the treatment
Severe Anemia - severe palmar pallor
At risk of death from:
1. Pneumonia
2. Diarrhea
3. Measles
4. Other severe diseases
Needs:
1. Urgent referral to a hospital
2. Special feeding
3. Antibiotics
4. Blood transfusion
27 Before discharge, give the child a dose of Vitamin A
 How to identify the treatment
Some Anemia – some palmar pallor

Needs:
1. Iron
2. Anti-malarial if infected
3. Mebendazole if infected

Give Mebendazole if the child is 2 years of age or older

and has not had a dose of Mebendazole in the last 6
months
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 How to identify the treatment

No Anemia

If the child is less than 2 years of age,

(5) assess the child’s feeding problems and

malnutrition

(7) counsel the mother about feeding her child

according to the recommendation in the
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Food Box on the Counsel the Mother
 Iron
 Under 12 months of age – Iron syrup
3 mg/kg - maintenance
5 mg/kg – treatment

 12 months or older – Iron tablets for 14 days

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 Iron and Anti malarial Drugs

 Iron/folate tablets may interfere with the action

of sulfadoxine-pyrimethanine that contains
antifolate drugs

 Give a child on anti-malarial drugs, iron/folate

during the follow-up or after treatment of two
weeks

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 Mebendazole

 Treats anemia by killing whipworms and

hookworms that cause anemia through
intestinal bleeding

 Mebendazole 500 mg/tab or five 100 mg/tab as

single dose

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 Follow-up Care

(a) advise the mother to bring back her child after

14 days of iron treatment

(b) continue to give the mother iron tablets when

she returns every 14 days for up to 2 months

(c) if after 2 months the child still has palmar

pallor, refer the child.
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 Case Study 1
 Erika is 18 months old and weighs 7 kg. She was brought by her mother today
because the child has had fever for 5 days and has a generalized rash. She
does not have cough, runny nose or difficult breathing. She does not have
diarrhea. She is able to drink, has not vomited, has not had convulsions, and is
neither lethargic nor unconscious.
 Erika lives where there is a high risk of malaria.
 The health worker checked for danger signs. The health worker saw that Erika
looks like skin and bones. Her temperature is 38.5 C. Her rash is generalized
She has red eyes but does not have mouth ulcers, pus draining from the eyes
nor clouding of the cornea. The rest of the physical examination is normal.
 The health worker next checked for malnutrition or anemia. Erika has visible
severe wasting. There is no palmar pallor. She does not have edema of both
feet. The health worker determined her weight for age.

Questions:
 Classify and assess the child’s condition.
 How are you going to manage the patient?

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 Case Study 2
 Michael is 11 months old and weighs 8 kg. His mother says that he has
had cough for at least 3 weeks Michael does not have diarrhea. He
has not had a fever during this illness. He does not have an ear
problem.
 He does not have any general danger signs. His temperature is 37 C.
He counted 41 breaths per minute. The health worker does not see
chest indrawing. There is no stridor when the child is calm.
 The health worker checked him for malnutrition and anemia. He does
not have visible severe wasting. His palms are very pale and appear
almost white. There is no edema of both feet. The health worker
determined Michael’s weight for age. Determine his weight for age.

Questions:
 Determine his weight for age.
 Assess and classify the patient’s condition.
 What are you going to advise the mother?

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 Case Study 3

 Alulu is 9 months old and weighs 5 kg. He is at the clinic today because his
mother and father are concerned about his diarrhea. He does not have cough
nor difficult breathing. He has diarrhea for 5 days. They have not seen blood in
the stool. He does not have fever nor an ear problem.
 He does not have any general danger signs. He is not restless or irritable. He is
not lethargic or unconscious. His temperature is 38 C. His eyes are not sunken.
He is thirsty and eager to take the drink of water offered to him. His skin pinch
goes back slowly.
 The health worker checked for malnutrition and anemia. The child does not
have visible severe washing. There is palmar pallor. He does not have edema
of both feet.
Questions:
 Determine weight for age.
 Assess and classify the child’s condition
 Does the patient need urgent referral?

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 Case Study 4
 Melvin is 37 months old and weighs 9.5 kg. His mother says that he feels hot
and has been crying and rubbing his ears. The mother noted ear discharge 5
days prior to consult and Melvin complained of ear pain. He has fever for 3
days accompanied by runny nose. He does not have cough, rashes nor
diarrhea. He is able to drink and does not vomit everything he drinks. He has
not had any convulsions.
 The risk for malaria is high in their area.
 He is neither lethargic nor unconscious. His temperature is 37.5 C. The health
worker sees pus draining from his ear and does not feel any tender swelling
behind either ear.
 He then checks the child for malnutrition and anemia. Melvin looks thin but
does not have visible severe wasting. He has some palmar pallor. He does not
have edema of both feet. The worker determined his weight for age.

Questions:
 Determine weight for age.
 Assess and classify the child’s condition
 What will you advise the mother?

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