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Malnutrition in children

In developing countries, 10.6 million children under the age of 5 die every year. 53% of these deaths are caused by malnutrition. About one quarter of all the world's children are malnourished. But hunger and malnutrition do not mean an actual lack of food. A healthy and balanced diet is very important, especially in the first 1,000 days of a person's life. The lack of micronutrients from a balanced diet may impede the physical and mental development of a child.

Definition, diagnosis, symptoms, treatment and prevention. Find out all there is to know about malnutrition in children:

Body Mass Index (BMI)

Malnutrition is an umbrella term for poor intake of food. This could be an excess consumption of nutrients (overnutrition) or inadequate consumption of nutrients (undernutrition). Undernutrition occurs when a person consumes fewer calories of energy than they need over a long period of time. The Body Mass Index (BMI) is a popular indicator of undernutrition. This is the weight of a person in relation to their height, and is determined by dividing the body weight in kilograms by the body height (in meters) squared. A person with a Body Mass Index (BMI) of 18.5 and lower is considered malnourished.

The BMI method for the diagnosis of malnutrition is certainly very useful, but has some drawbacks, especially in situations in which many people have to be examined at the same time. Measuring and weighing many people can be time consuming. In addition, scales and measuring tapes (preferably several) must be available and the personnel must be trained accordingly. These conditions are not always met, especially in developing countries.

Diagnosis using Mid-Upper Arm Circumference (MUAC) tape

A child doing the MUAC test in Kenya
The MUAC test shows that this child is manourished © African Visuals Media/Malteser International

MUAC is currently a quick and simple way to determine whether or not a child is malnourished using a simple colored plastic tape.

The MUAC test can be used on children from the age of 12 months up to the age of 59 months, but can also be used to determine malnutrition in children over six months with length above 65cm. Most MUAC tapes have three colored zones with which the nutritional state of a child can be determined.

The tape measure is placed between the elbow:

  • a measurement in the green zone (12cm to 21cm) means the child is properly nourished
  • a measurement in the yellow zone (11cm to 12.5cm) means that the child is at risk of malnutrition
  • a measurement in the red zone (below 11cm) means that the child is acutely malnourished.

Currently, a variant of the bracelet for older children and adults is under development.

Severe consequences of child malnutrition on health

Malnourished children show symptoms like weakness, tiredness and apathy
Malnourished children show symptoms like weakness, tiredness and apathy © Malteser International

Children who are underweight are often too small for their age. They also show many other symptoms like weakness, tiredness and apathy. In many cases, there is delayed mental development, reduced muscle mass as well as impaired intellectual development.

One form of undernutrition in children is Marasmus. This occurs in children that don’t ingest enough protein, calories, carbohydrates, and other important nutrients. Kwashiorkor is another form of serious malnutrition. The name is derived from the Ghanaian language Ga and loosely translates to "the sickness the baby gets when the new baby comes". Kwashiorkor causes a buildup of fluid in the body that can cause the face to become round and the belly to become distended. The bulge of the abdomen is caused by water retention in the abdominal cavity and a greatly enlarged liver.  Kwashiorkor occurs in people who have a severe protein deficiency. Children who develop kwashiorkor are often older than children who develop marasmus. Having a diet that’s mainly carbohydrates can lead to this condition.

Malnutrition affects every system in the body and always results in increased vulnerability to illnesses like tuberculosis, increased complications and in very extreme cases even death.

Plumpy’Nut – fighting malnutrition with peanut paste

Peanut paste quickly strengthens a malnourished child © African Visuals Media/Malteser International

A child is “slightly malnourished” if a conducted MUAC test falls within the yellow zone or if they weigh only about 70-80% of their normal weight. Such a child will need to be treated with calorie- and vitamin-rich supplements.

For years, children with acute malnutrition have been treated by medical professionals in clinics, but today a simple innovation in a plastic sachet is saving the lives of millions of children – It is the Ready-to-Use Therapeutic Food (RUTF), a peanut-based paste that treats nutritional deficiencies in children, particularly children suffering from severe acute malnutrition. The best-known RUTF is Plumpy’Nut.

The paste contains sugar, vegetable oil and skimmed milk powder, and enriched with vitamins and minerals. It is easily ingested by little children, and doesn't need to be mixed with water, which is often scarce in regions affected by drought. It is also inexpensive: just €5 can provide a month’s worth of this therapeutic food.

Treating children with severe malnutrition

The treatment of acutely malnourished or malnourished children follows a 10-point scheme developed by the World Health Organization (WHO).

  • Treatment of low blood glucose levels. Glucose can be administered orally or intravenously.
  • Treatment of hypothermia, a condition of having an abnormally low body temperature. Regular
  • Monitoring of body temperature. Blankets can provide warmth for children.
  • Treatment of dehydration using special rehydration solutions for malnutrition. Care should be taken during rehydration to avoid flooding the circulation and overloading the heart.
  • Correction of electrolyte imbalance. This can be done by administering extra potassium and magnesium to a child’s food.
  • Treatment and prevention of infection. Because of the extremely weakened immune system, infections can occur without symptoms, so as a precaution, children should receive an antibiotic that prevents a broad range of infections. In addition, children in stable condition are vaccinated against measles.
  • Correction of nutritional deficiencies; supplementation with vitamins and trace elements, especially vitamin A, zinc, folic acid and iron.
  • Cautious feeding. In the stabilization phase, nutrition is carefully commenced to avoid overloading the weakened body. Small but several portions are given, which should contain about 100 kcal per kilogram of body weight in children. In addition, enough fluid (100-130 ml per kilogram of body weight) should be administered.
  • Promoting weight gain. In the rehabilitation phase, a vigorous approach to feeding is necessary in order to rapidly gain weight. The increase should be observed at regular intervals and ideally amounts to around 10 grams per kilogram of body weight per day.
  • Creating a positive and empowering environment. Since malnutrition often brings with it a delay in mental development, attention should be paid to a stimulating and protective environment.
  • Regular follow-up checks and immunizations

Prevention of malnutrition and undernutrition

Mothers and families need to be educated about healthy and child-friendly nutrition to prevent malnutrition in children. Mothers should be encouraged to breastfeed their babies, because breastfeeding ensures the full development of a child’s immune system. During this time, it is equally important that mothers are properly nourished.

It is also important to have a balanced diet. In many regions in which malnutrition is prevalent, people traditionally eat foods that are often too high in carbohydrates and too low in vitamins. The diet usually contains cereals such as rice or millet, but lacks vegetables and fruits that provide essential vitamins. Good nutrition from birth to three years is the most important foundation for baby to grow healthy and bright. In our nutrition training sessions, we work with mothers to increase the quality and security of nutrition for them and for their children. In many cases, we also supplement these courses with training in fruit and vegetable cultivation and start-up aids in the form of seeds or agricultural equipment.

20 euros could buy 1 child a warm lunch for 3 months
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40 euros could buy seeds and farm tools for 1 household
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100 euros could provide therapeutic feeding for 3 children
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