PEADS WARD

Disease -1

Acute malnutrition:
Acute malnutrition is a form of under-nutrition caused by a decrease in food
consumption and/or illness that result in sudden weight loss or oedema (fluid retention).
Acute malnutrition can be moderate or severe, and prolonged malnutrition can cause stunted
growth, otherwise known as stunting.

Symptoms:
 ∙ Reduced appetite.
 ∙ Lack of interest in food and drink.
 ∙ Feeling tired all the time.
 ∙ Feeling weaker.
 ∙ Getting ill often and taking a long time to recover.
 ∙ Wounds taking a long time to heal.
 ∙ Poor concentration.
 ∙ Feeling cold most of the time.

Etiology:
 ∙ Cancer.
 ∙ Liver disease.
 ∙ Conditions that cause nausea or make it difficult to eat or swallow.
 ∙ taking medications that make eating difficult due to nausea

Treatment:
A meta-analysis in 2013 of 2767 children with all grades of Acute Malnutrition pooled from
observational data assessed the antibiotic resistance of blood, urine and CSF cultures. Apart from
the improved susceptibility of amoxicillin over co-trimoxazole (as described above), the analysis
also documented that the susceptibilities of chloramphenicol and amoxicillin–clavulanate were
73.7% and 30.7%, respectively. Gentamicin, amoxicillin–gentamicin, ceftriaxone and
ciprofloxacin had the highest rates of susceptibility (>80%)

Dietary Management:
1. F75 and F100
F75 and F100 are specially formulated milks used in inpatient settings to treat Acute
Malnutrition. F75 is given in the stabilization phase of inpatient treatment; children are provided
with approximately 80–100 kilocalories per kilogram per day (kcal/kg/d) spread over 8–12 meals
per day for three to seven days. F75 is not designed for weight gain F100 is given during the
rehabilitation phase of inpatient treatment of Acute Malnutrition. Because F75 and F100 require
preparation and have high moisture content, they cannot be stored for long at room temperature
for food safety reasons, and are not given to caretakers to prepare at home.

2. Ready-to-use-foods (RUFs
Ready-to-use-foods (RUFs) are specially formulated bars, pastes, or biscuits that provide varying
ranges of high-quality protein, energy, and micronutrients. These products are more nutrient
dense than available home foods and do not require preparation; they typically have very low
moisture content and are resistant to microbes. With use of each of these products, continued
breastfeeding is recommended.
 Ready-to-use therapeutic foods (RUTFs), such as Plumpy’Nut are designed for the
treatment of uncomplicated Acute Malnutrition.
 Ready-to-use supplementary foods (RUSFs), such as Plumpy’Sup, are designed as a
supplement to treat Acute Malnutrition.
 Medium-quantity lipid-based nutrient supplements (LNSs), such as Plumpy’Doz, are
designed as a supplement to prevent Acute Malnutrition.
3. Fortified blended flours (FBFs)
Fortified blended flours (FBFs) are an additional class of specially formulated foods. The most
commonly used product is Supercereal Plus, formerly called Corn Soy Blend Plus (CSB++).
FBFs require some preparation before consumption and are typically distributed in larger
quantities as family rations for treating or preventing Acute Malnutrition

Disease -2

Stunting:
Stunting is the impaired growth and development that children experience from poor
nutrition, repeated infection, and inadequate psychosocial stimulation. Children are defined
as stunted if their height-for-age is more than two standard deviations below the WHO
Child Growth Standards median
.
Symptoms:
Some of those consequences include poor cognition and educational performance, low adult
wages, lost productivity and, when accompanied by excessive weight gain later in childhood,
an increased risk of nutrition-related chronic diseases in adult life
Etilogy:
Iodine is necessary for the thyroid hormones that regulate growth, development, and
metabolism and is essential to prevent goiter and cretinism. Inadequate intake can result in
impaired intellectual development and physical growth.

Treatment:
Dietary deficiency of zinc, iron, calcium, and vitamin A are especially common and often
occur together. Zinc is essential for adequate growth, and supplements have been shown to
increase intrauterine femur length and to prevent stunting.

Diet Recommendation:
Adherence to dietary patterns high in protein (e.g. dairy, legumes, and meat products) and
carbohydrates (e.g. fruits, sweets, and desserts) might be associated with reduced odds of
being stunted among children
Vitamin A plus Zinc
Main function of zinc is essential for normal linear growth on children. Zinc also play
important role in synthesis RNA and DNA.
Zinc related to metabolism of Vitamin A, its mean that zinc linked with several function of
Vitamin A, thus zinc is needed in Vitamin A synthesis
Study in South Africa showed different outcome, increment of height-for-age was higher in
the group with micronutrient than group with Vitamin A alone or Vitamin A with Zinc.
Management of stunting that effective to improve child growth and cognition is giving
vitamin A with adding of zinc, giving multiple micronutrient, and giving health education
about nutrition and responsive stimulation on mother with stunted children.
Micronutrient with Omega-3
Docosahexaenoic acid (DHA) and arachidonic acid (AA) is essential for child growth and
development. N-3 and N-6 LCPUFA (long chain polyunsaturated fatty acid) is essential for
infant.and child brain development, including several neuron process.
There is high concentration of DHA in main nervous system, and accumulated in third
trimester of pregnancy and the first 2 years in postpartum, the main source of DHA after
birth is in the breast milk.
The effectiveness of giving omega-3 to improve growth and cognition in less known
because between omega-3 and micronutrient, micronutrient has higher effect.
 Disease -3

Wasting:

Child wasting refers to a child who is too thin for his or her height and is the result of recent
rapid weight loss or the failure to gain weight. A child who is moderately or severely wasted
has an increased risk of death, but treatment is possible

Symptoms:
 ∙ Persistent dizziness.
 ∙ Lack of energy.
 ∙ Dry skin.
 ∙ Brittle hair.

Etiology:
Wasting and other forms of acute malnutrition are the result of maternal malnutrition,
low birthweight, poor feeding and care practices, and infection exacerbated by food
insecurity, limited access to safe drinking water, and poverty

Treatment:
In most cases, children with wasting can be treated with ready-to-use therapeutic food
(RUTF), allowing them to recover in their own homes and communities rather than in a
health facility

Diet recommendation:
The Positive Deviance Hearth (PDH) model which recommends the following (for
treatment of underweight) in terms of nutrient requirements for a meal:
 Calories: 600–800 (500–600)
 Protein: 25–27g (18–20g)
 Vitamin A: 300 μg RAE (RAE=retinol activity equivalent)
 Iron: 8–10mg
 Zinc: 3–5mg
 Vitamin C: 15–25mg
Children need a balanced diet with food from all 3 food groups
 vegetables and fruit
 whole grain products,
 protein foods.
Children need 3 meals a day and 1 to 3 snacks (morning, afternoon and possibly before
bed). Healthy snacks are just as important as the food you serve at meals.

Disease -4
Anemia:
Anemia is a condition in which you lack enough healthy red blood cells to carry adequate
oxygen to your body's tissues. having anemia, also referred to as low hemoglobin, can make
you feel tired and weak. There are many forms of anemia, each with its own cause

Symptoms:
 ∙ Fatigue.
 ∙ Weakness.
 ∙ Pale or yellowish skin.
 ∙ Irregular heartbeats.
 ∙ Shortness of breath.
 ∙ Dizziness or lightheadedness.
 ∙ Chest pain.
 ∙ Cold hands and feet.

Etiology:
The most common cause of anemia is low levels of iron in the body. This type of anemia is
called iron-deficiency anemia. Your body needs a certain amount of iron to make
hemoglobin, the substance that moves oxygen throughout your body

Treatment:
Treatment might include oxygen, pain relievers, and oral and intravenous fluids to
reduce pain and prevent complications. Doctors might also recommend blood transfusions,
folic acid supplements and antibiotics. A cancer drug called hydroxyurea (Droxia, Hydrea,
Siklos) also is used to treat sickle cell anemia

Diet recommendation:
A well balanced diet with adequate calories and good quality protein, foods rich in iron, folic
acid, Vitamin ‘B12’ & ‘C’ needs to be taken.
1. Eat often and eat small meals that help in better absorption and digestion.
2. Include protein-rich foods
 Sources of protein for vegetarians are milk, curds (yoghurt), cheese, soya nuggets, tofu and
paneer.
In addition to above, sources of protein for non-vegetarians are eggs, lean meats like fish and
chicken.
3.Eat Vitamin / Mineral-rich foods Iron-rich Foods :
 Cereals and millets : Bajra, ragi, whole wheat flour, puffed rice and rice flakes.
 Legumes : Horse gram, moth beans, lentils, bengal gram dal, rajmah, peas dry, cow peas.
Non vegetarian : Chicken liver, egg yolk, mutton, chicken.
 Dark green and leafy vegetables like curry leaves powder, mint chutney, gogu, methi,
amaranth, drumstick leaves, onion stalks etc. daily.
 Nuts and oil seeds : Til, chia seeds, groundnuts, flax seeds, almonds and pista, melon
seeds, coconut dry. Dry fruits : Raisins, black dates, apricot.
4.To further enhance iron absorption from these iron-rich foods :
 Take Vitamin C-rich foods like amla, guava, berries, melon, mango, pineapple, citrus
fruits, lime juice etc. along with your meals.
 Use of double fortified salt (iron + iodine) is recommended.
5.Avoid the following :
 Do not drink tea or coffee with your meals. Take it an hour before or after the meal.
 Don’t combine an iron-rich meal with many calcium-rich foods like milk,cheese, paneer
etc.
 Too much fiber in the diet also affects the iron absorption. Avoid refined and processed
foods
 Limit intake of pasta, noodles, polished rice, ready-to-eat foods, etc.
 Avoid pickles
6.Dietary sources of folic acid
 Green leafy vegetables – Amaranth, ambat chukka, spinach, mint.
 Oil seeds like gingelly (til) and soya bean
 Orange juice
 Chickpeas
 Other legumes like green gram and red gram
 Black-eyed beans, cluster beans
7.Dietary sources of B12 :
Shellfish, liver, fish, lamb, egg and low fat dairy products 4.
8.Fluids :
Minimum intake of 2½ -3 litres / day

. Disease -5
 Rickets:-

Rickets is a condition that affects bone development in children. It causes bone pain, poor
growth and soft, weak bones that can lead to bone deformities. Adults can experience a
similar condition, which is known as osteomalacia or soft bones. Read more about the signs
and symptoms of rickets and osteomalacia.

Symptoms:
pain – the bones affected by rickets can be sore and painful, so the child may be reluctant to
walk or may tire easily; the child's walk may look different (waddling) skeletal deformities –
thickening of the ankles, wrists and knees, bowed legs, soft skull bones and, rarely, bending
of the spine.

Etiology:
A lack of vitamin D or calcium is the most common cause of rickets.

MNT:
As most cases of rickets are caused by a vitamin D and calcium deficiency, it's usually
treated by increasing a child's intake of vitamin D and calcium. Vitamin D and calcium levels
can be increased by: eating more foods that are rich in calcium and vitamin D. taking daily
calcium and vitamin D supplements.

 Sunlight: Your body makes vitamin D when exposed to sunlight, so it's harder for people
with darker skin to make vitamin D if they spend a lot of time indoors (or for people who
only go outside with sunscreen on).
 Vitamin D-rich foods: Several varieties of fish (especially sockeye salmon and rainbow
trout) are especially rich in vitamin D. Several foods are also “fortified” with vitamin D,
which means that vitamin is added to them. Milk, orange juice and cereals are often
fortified this way.