17 Nutrition Care Process on Pediatric Malnutrition

Summary

This presentation by a nutritionist dietitian from the Philippine Children's Medical Center explores pediatric malnutrition and the nutrition care process. It covers the impact of malnutrition on hospitalized children, with a focus on its long-term consequences such as impaired cognitive function, stunting, and increased healthcare costs. The session emphasizes evidence-based approaches to diagnosing and managing malnutrition, involving a multidisciplinary team. A case study of a 12-month-old child with acute malnutrition is discussed, showcasing interventions and monitoring strategies to improve the child's nutritional status. The overall goal is to highlight the importance of early detection and effective treatment in addressing pediatric malnutrition.

Takeaways

• 😀 Pediatric malnutrition is an imbalance between nutrient intake and requirements, affecting a child's growth and development, especially during the critical first two years of life.
• 😀 Chronic malnutrition can severely affect cognitive functions, educational recall, and adult income, making it a major concern for public health and economic policy.
• 😀 In the Philippines, about a third of children under five years old are stunted, and the country has one of the highest burdens of stunting in ASEAN despite improvements over the last few decades.
• 😀 Malnutrition in children can lead to immune dysfunction, increased infections, delayed wound healing, and longer hospital stays, emphasizing the importance of early diagnosis and intervention.
• 😀 Acute malnutrition, or wasting, is indicated by a significant weight loss over a short period, while chronic malnutrition, or stunting, affects height over a prolonged period of inadequate nutrition.
• 😀 Accurate diagnosis of pediatric malnutrition requires using appropriate indicators like weight-for-height, length-for-age, BMI, and upper arm circumference, depending on the child's age.
• 😀 Malnutrition can be categorized as mild, moderate, or severe, and understanding its etiology—whether illness-related or due to environmental factors—is essential for targeted interventions.
• 😀 A multidisciplinary approach involving nurses, physicians, dietitians, and other healthcare professionals is key to addressing pediatric malnutrition effectively and reducing the length of hospital stays.
• 😀 In a clinical setting, a structured nutrition care process should be followed, including assessing nutrition risk, developing a nutrition plan, monitoring intake, and providing follow-up care.
• 😀 Case studies, like the one presented with patient 'JJ,' illustrate the practical application of nutrition interventions, such as using specific formulas and addressing feeding practices to improve the child’s nutritional status.

Q & A

What is pediatric malnutrition, and how is it different from adult malnutrition?

Pediatric malnutrition refers to an imbalance between nutrient requirements and intake, which negatively affects a child's development and health outcomes. Unlike adults, children need to grow and develop, and malnutrition in children can have permanent effects, especially during the crucial first two years of growth and brain development.

What are the three main causes of poor nutritional intake in pediatric patients?

The three main causes are decreased intake or starvation, nutritional losses (e.g., from malabsorption or burns), and increased nutritional needs due to the catabolic effects of diseases or conditions requiring catch-up growth.

How is wasting in children defined, and what does it indicate?

Wasting is defined as a weight-for-age that is more than two standard deviations below the median, indicating acute malnutrition. It is often visible when a child suddenly loses weight over a short period due to insufficient food intake or illness.

What is stunting in children, and how does it differ from wasting?

Stunting is defined as a height-for-age more than two standard deviations below the median, indicating chronic malnutrition. Unlike wasting, stunting occurs over a long period and affects a child's growth in height rather than weight.

What are the immediate consequences of pediatric malnutrition?

The immediate consequences include increased risk of premature death, immune dysfunction, and delayed wound healing. Malnourished children also face higher risks of infections, longer hospital stays, and impaired cognitive development.

What role does inflammation play in pediatric malnutrition?

Inflammation plays a significant role in malnutrition by altering nutrient utilization. It can lead to hypercatabolism, where the body breaks down its own tissues for energy, exacerbating the nutritional deficits.

Why is early diagnosis and timely intervention critical for pediatric malnutrition?

Early diagnosis and intervention are crucial because malnutrition can lead to long-term issues such as cognitive impairment, poor immune function, and sub-optimal development. Timely management improves health outcomes, reduces hospital stays, and decreases healthcare costs.

What are some key indicators used to diagnose pediatric malnutrition?

Key indicators for diagnosing pediatric malnutrition include weight-for-height or length-for-age Z-scores, BMI Z-scores, and mid-upper arm circumference (MUAC). These help determine the severity and type of malnutrition, whether acute or chronic.

What are the goals of a multidisciplinary approach to managing pediatric malnutrition?

The goals of a multidisciplinary approach are to reduce unnecessary lab tests, ensure consistent care, decrease hospital length of stay, and increase the involvement of dietitians and other healthcare professionals in malnutrition diagnosis and treatment.

How should the nutrition care process be structured for children with malnutrition?

The nutrition care process involves assessing nutritional risk, diagnosing the nutritional status, developing a treatment plan, monitoring intake and status, and planning discharge with follow-up care. Documentation should include the chronicity, degree, and etiology of malnutrition to guide interventions.