How to Identify Malnutrition in Children

Summary

This video script educates community health workers on identifying malnutrition in children through three methods: tracking growth by weight and height, measuring mid-upper arm circumference (MUAC), and checking for nutritional edema in the feet. It emphasizes the importance of regular monitoring, accurate measurements, and immediate referral to health facilities for severe cases. The script also advises on counseling families for prevention and supplementary feeding programs.

Takeaways

• 📏 Regularly weigh and measure the height or length of children to monitor growth and identify malnutrition.
• 📊 Use growth charts to track and compare a child's growth curve against expected growth patterns for healthy children.
• 🚨 If a child's growth curve flattens or deviates from the expected curve, it may indicate malnutrition or illness, necessitating further care or referral.
• 👕 Refer children with growth issues to health facilities for accurate weighing and measuring if you cannot do so.
• 📏 The mid-upper arm circumference (MUAC) measurement is a tool to identify severe malnutrition, particularly in children aged six months to five years.
• 🟥 A red MUAC reading or measurement below 11.5 cm indicates severe malnutrition, requiring urgent referral to a health facility.
• 🟨 A yellow MUAC reading between 11.5 and 12.4 cm, especially in HIV-positive children, also warrants urgent referral.
• 🟩 A green MUAC reading close to yellow or a measurement between 12.5 and 13.4 cm suggests the child is at risk of malnutrition and requires nutritional counseling.
• 🟩 A green reading above 13.4 cm is considered normal, but should still be used in conjunction with other nutritional assessments.
• 🦶 Check for nutritional oedema by pressing the top of each foot; dents remaining after pressure indicates severe malnutrition and requires immediate referral.
• 🛑 Early identification of malnutrition can prevent severe health outcomes such as hospitalization or death, emphasizing the importance of these monitoring methods.

Q & A

What is the primary role of a community health worker in identifying malnutrition?

A community health worker's primary role in identifying malnutrition is to monitor a child's growth, perform mid-upper arm circumference (MUAC) measurements, and check for swelling in both feet to determine the child's nutritional status.

How can a child's growth be monitored for signs of malnutrition?

A child's growth can be monitored by regularly weighing them and measuring their height or length, tracking these measurements on a growth chart, and comparing them to the expected growth lines for a healthy child.

What should be done if a child's growth curve starts to deviate from the expected growth pattern?

If a child's growth curve deviates from the expected pattern, it indicates a potential problem. The health worker should inquire about the child's eating habits and health, and if necessary, refer the child to a health facility for further evaluation and care.

What is the purpose of referring a child to a health facility for growth measurements?

Referring a child to a health facility for growth measurements ensures that the child receives accurate assessments and can receive appropriate care if malnutrition or other health issues are detected.

Can you explain the process of measuring a child's height or length for growth monitoring?

To measure a child's height or length, the child's age and the measurement are marked on the growth chart at the point where the age and measurement lines intersect. Over time, these points are connected to form a growth curve, which is then compared to the expected growth lines.

What is the significance of the mid-upper arm circumference (MUAC) measurement in identifying malnutrition?

The MUAC measurement is significant as it can identify a type of severe malnutrition called marasmus. It measures the circumference of the upper arm, and a small arm circumference indicates loss of muscle mass, which is crucial for body functions and fighting infections.

How is the mid-upper arm circumference (MUAC) measured in children?

The MUAC is measured by using a color-coded tape, bending the child's arm at a 90-degree angle, finding the midpoint of the arm, and wrapping the tape around the arm without pulling it too tight or too loose. The measurement is read in centimeters and the color indicates the child's nutritional status.

What does a red reading or measurement of less than 11.5 centimeters on the MUAC tape indicate?

A red reading or measurement of less than 11.5 centimeters on the MUAC tape indicates severe malnutrition, which is a danger sign requiring urgent referral to a health facility.

What is nutritional oedema, and how can it be identified in children?

Nutritional oedema is a condition where fluid accumulates in the body due to severe malnutrition, often caused by inadequate protein intake. It can be identified by checking for swelling in both feet, where pressing the top of each foot and observing if dents remain after lifting the thumb indicates the condition.

Why is it important to refer a child with nutritional oedema to a health facility immediately?

It is important to refer a child with nutritional oedema immediately because it is a danger sign of severe malnutrition that requires prompt medical intervention to prevent complications, hospitalization, or even death.

How can community health workers prevent malnutrition in children?

Community health workers can prevent malnutrition by regularly monitoring children's growth, performing MUAC measurements, checking for signs of nutritional oedema, and providing counseling to families on good nutrition practices.

Outlines

00:00

📏 Monitoring Growth for Malnutrition Identification

This paragraph emphasizes the importance for community health workers to identify malnutrition through monitoring a child's growth. It outlines three methods: regular weighing and height measurement, mid-upper arm circumference (MUAC) measurement, and checking for foot swelling. The focus is on how to track a child's growth curve using growth charts, which should fall within the expected range for a healthy child. Deviations from this curve may indicate malnutrition, and steps to take in such cases, including referral to a health facility, are discussed. The paragraph also provides a step-by-step guide on how to weigh and measure a child and interpret the results.

05:02

📏 Additional Methods for Detecting Malnutrition

The second paragraph delves into alternative methods for identifying malnutrition when regular growth monitoring isn't possible. It explains the use of the mid-upper arm circumference (MUAC) measurement to detect marasmus, a severe form of malnutrition, and notes its limitations in identifying stunting. The paragraph provides detailed instructions on how to perform a MUAC measurement, including the use of a color-coded tape and what the different color readings signify. It also introduces the concept of nutritional oedema, another indicator of malnutrition, which is identified by checking for swelling in a child's feet. The importance of early detection and appropriate referral to prevent severe malnourishment and its complications is highlighted.

Keywords

💡Malnutrition

Malnutrition refers to a state where the body is not getting the right nutrients it needs to function properly. It can be caused by not eating enough, eating an unbalanced diet, or the body not being able to use the food it eats properly. In the video, malnutrition is the central theme, focusing on its identification in children, which is crucial for community health workers to prevent severe health issues.

💡Growth Monitoring

Growth monitoring is the regular tracking of a child's physical development, including weight and height or length, to ensure they are growing properly. The video emphasizes its importance as the first method to identify malnutrition, by comparing a child's growth curve to expected growth patterns on charts and noting any deviations that may indicate a problem.

💡Mid-Upper Arm Circumference (MUAC)

MUAC is a measurement of the distance around a child's upper arm and is used to identify a type of severe malnutrition known as marasmus. The script explains how to perform this measurement and interpret the results using a color-coded tape, which is a key tool in assessing a child's nutritional status when regular growth monitoring is not possible.

💡Swelling

Swelling, particularly in the context of the video, refers to nutritional oedema, a condition where there is an abnormal accumulation of fluid in the body due to malnutrition. The video describes a method to check for this by pressing the top of a child's feet and observing if dents remain, which, if present, is a sign of severe malnutrition requiring immediate medical attention.

💡Growth Chart

A growth chart is a graphical representation used to monitor and evaluate a child's growth over time. It is referenced in the video as a tool to mark and track a child's weight and height, and to compare their growth curve against expected growth patterns. Any significant deviation from these patterns can be an indicator of malnutrition.

💡Marasmus

Marasmus is a specific type of severe malnutrition characterized by significant weight loss and muscle wasting. The video script mentions that MUAC measurement can identify marasmus, highlighting its importance as a method to detect this condition in children.

💡Nutritional Oedema

Nutritional oedema, as described in the video, is the swelling that occurs due to malnutrition, particularly due to a lack of protein. It is a sign of another form of severe malnutrition called Kwashiorkor and is identified by the presence of dents in a child's feet after pressing, indicating the need for urgent medical attention.

💡Health Facility

A health facility in the context of the video refers to a medical center or clinic where children can be weighed, measured, and receive professional assessments for malnutrition. The script suggests referring children to health facilities if there are signs of malnutrition or if growth monitoring cannot be performed regularly.

💡Supplementary Feeding Programme

A supplementary feeding programme is a type of intervention aimed at providing additional nutrition to individuals who are at risk of malnutrition. The video mentions referring children with certain MUAC measurements to such programmes, indicating a proactive approach to prevent malnutrition from worsening.

💡Counseling

Counseling, in the context of the video, involves advising and educating families on proper nutrition and feeding practices to prevent or address malnutrition. It is highlighted as an important step after identifying a child at risk of malnutrition, aiming to empower families to improve the child's nutritional status.

💡Risk of Malnutrition

The risk of malnutrition refers to the likelihood of a child developing malnutrition due to various factors such as inadequate diet or health issues. The video script discusses the importance of identifying this risk early through growth monitoring and MUAC measurements, so that preventive measures can be taken.

Highlights

Importance of identifying malnutrition for community health workers.

Three main methods to identify malnutrition: monitoring growth, MUAC measurement, and checking for foot swelling.

Regular weighing and height measurement to track a child's growth curve.

Referring children to health facilities for growth measurements if not possible at the visit.

Interpreting growth chart results to determine if a child is growing well.

Signs of malnutrition when a child's growth curve flattens or deviates from the expected path.

The role of the mid-upper arm circumference (MUAC) measurement in identifying severe malnutrition.

MUAC measurement limitations in detecting malnutrition that leads to stunting.

Instructions for using a colour-coded MUAC tape to measure the upper arm circumference.

Interpreting MUAC tape colour and measurement to assess a child's nutritional status.

Urgent referral to health facilities for children with severe malnutrition indicated by MUAC.

The significance of nutritional oedema in identifying malnutrition that appears as swelling in feet.

Technique for checking for nutritional oedema by pressing the top of the child's feet.

Immediate referral required if nutritional oedema is present in both feet.

The necessity of combining MUAC with other nutritional assessments for a comprehensive evaluation.

Importance of early identification of malnutrition to prevent severe health outcomes.

Additional resources available for learning how to care for a child with malnutrition.

Transcripts

How to identify malnutrition.

As a community health worker it is important for you

to know how to identify malnutrition.

There are three main ways to do this.

1. Monitoring a child's growth by regularly weighing them

and measuring their height or length.

2. Doing a mid-upper arm circumference or MUAC measurement.

3. Checking for swelling of both feet.

This video will show you how to do each of these.

How to monitor growth.

Healthy children should always be growing in height

or length and gaining weight.

John, how can you identify if a child is not growing well?

The most effective way to identify

malnutrition is to weigh and measure the height

or length of a child at every visit

and track these measurements on the child's growth charts.

This helps you determine how well the child is growing.

If you are not able to do this, refer the child to a health facility

where they will do the weighing and measurements.

Let me show you how to weigh and measure a child

and how to interpret the results.

Start by weighing the child.

Mark the child's weight as a dot on the growth chart

at the point with the age and the weight lines cross.

Next, measure the child's height or length

and mark this on the relevant charts.

Over time, you will join the dots to show the child's growth curve.

You will then compare the child's growth curve to the lines on the charts,

which indicate the expected growth for a healthy child.

The child's growth curve should fall between the outer two lines on the charts

and be tracking steadily along their expected growth curve over time.

If the child's growth starts flattening out

or falling off their expected curve, this indicates a problem.

Ask if the child has not been eating well or has been sick.

If the child falls off their expected curve,

the child may be ill or need extra care.

If this carries on or shows a sudden drop,

the child should be referred to a health facility.

If the child's growth is below the bottom curve

or above the top curve on the chart,

this may indicate a risk and the child should be referred.

Refer to your standard training for how to do these measurements accurately,

as well as how to complete and interpret

the specific growth charts for your country.

How to measure the mid-upper arm circumference.

John, what can you do if you do not have the opportunity

to weigh and measure a child over time?

The mid-upper arm circumference measurement

can identify a type of severe malnutrition called marasmus.

However, it may not be as effective in picking up malnutrition

that leads to poor growth, such as stunting.

It can be used in children between the ages of six months and five years.

For a child younger than six months,

a low weight for their length and age

are useful indicators of malnutrition.

A colour coded mid-upper arm circumference tape

is used to measure the circumference or distance around the upper arm.

A small arm circumference or red

on the tape indicates the loss of muscle mass,

which is important in maintaining body functions and fighting infections.

When using a standard or graduated mid-upper arm circumference tape follow these steps:

Remove the clothing from the child's less used arm

and bend the elbow at a 90º angle.

Find the top of the shoulder.

Place the tape from the top of the shoulder

to the tip of the elbow (endpoint).

Fold the endpoint to the top edge of the tape

to find the middle of the arm

or midpoint and mark it with a finger or pen.

Straighten the child’s arm and hold the white large part of the tape

on the child's upper arm at the midpoint.

Wrap the other end of the tape around the child's arm.

Thread the narrow coloured tape up through the small slit

until the tape fits the child's arm closely.

Do not pull the tape too tight or have it too loose.

Press the window against the arm

and read the measurement in centimetres

in the window between the two arrows.

Also, look at the colour that appears in the window.

If you can, repeat the steps to make sure of the result.

The colour and reading in centimetres

will indicate the child's nutritional status.

A red reading or measurement of less than 11.5 centimetres

means that the child has severe malnutrition.

This is a danger sign, and you need to refer

the child urgently to a health facility.

If the child has a yellow reading or measurement

of between 11.5 and 12.4 centimetres and is living with HIV,

you will refer the child urgently to a health facility.

If the child has a yellow reading and is not living with HIV,

you should refer them to a supplementary feeding programme if you can.

Counsel the family on feeding and make sure to follow up with the child.

A green reading close to the yellow

or a measurement of between 12.5 and 13.4 centimetres

means that the child is at risk of malnutrition.

Counsel the family on good nutrition

so that they can prevent the child from becoming malnourished.

A green reading of more than 13.4 centimetres is normal.

While the mid-upper arm circumference is a valuable tool,

it should ideally be used with other nutritional assessments

such as weight-for-height or weight-for-age,

to get a better picture of a child's nutritional status.

How to check for swelling in both feet.

John, it is important to note that children with malnutrition

do not always look thin and wasted.

Kwashiorkor, which is also a type of severe malnutrition

due to inadequate protein, can cause a lot of fluid to gather in the body.

This makes the child look round and plump, especially in the abdomen.

Yes, this swelling that you mentioned is called nutritional oedema.

and the best way to identify this is to look at the child's feet.

Gently press with your thumbs on the top of each foot for three seconds.

Then, lift your thumbs.

If dents remain on the top of both feet,

then the child is severely malnourished.

This is a danger sign and the child must

be referred immediately to a health facility.

Remember, for the sign to be present,

the dents must show clearly on both feet.

Use these methods to check for malnutrition in a child.

The earlier you identify malnutrition or the risk of it,

the sooner you can help get the child

the proper care and nutrition they need.

This can prevent severe malnourishment,

being hospitalised or even death.

Take a look at another video

on how to care for a child with malnutrition.

on how to care for a child with malnutrition.