Protein Energy Malnutrition Symptoms, Examples, Classification in Children and its homeopathic management

Protein Energy Malnutrition In Under Five Children And It’s Homeopathic Management

ABSTRACT

Protein Energy Malnutrition – PEM is a range of pathological conditions arising from coincident lack, in varying proportion, of protein and calories occurring most frequently in young children and infants and commonly associated with infection. This article reviews about types of malnutrition, classification, indicators, epidemiology, clinical features, prevention, general management and its homeopathic management.

KEYWORDS

Protein energy malnutrition, kwashiorkor, marasmus, homeopathic management

ABBREVIATION

PEM-Protein Energy Malnutrition, WHO-World Health Organization

INTRODUCTON

Protein energy malnutrition can be defined as the impaired growth primarily due to inadequate intake food. Deficiency can be in both macronutrients and micronutrients.it is most wide spread condition affecting health of children, it makes the child more susceptible to infection, recovery is slower and mortality is higher and these children shall have reduced physical and mental health.

EPIDEMOLOGY

The prevalence of stunting among under five children India is 48% and wasting is 20% and with an underweight prevalence of 43%, it is highest in the world.

DETERMINANTS OF PEM

Environmental factors including the physical and social environment, behavioral factors, healthcare services related, biological factors and socio cultural factors including improper feeding technique and nutritional status of the mother.

CLASSIFICATION

Table1:WHO classification of malnutrition based on mid-arm circumference

Normal

13.5cm-16cm

Mild to moderate

12.5cm-13.4cm

Severe

Less than12.5cm

INDICATORS

Table2: Indicators of PEM

Indicators

Interpretations

 

Stunting

low height for age

Chronic malnutrition

Wasting

Low weight for age

Acute malnutrition

Under weight

Low weight for height

Combination of both acute and chronic malnutrition

 

TYPES

Based on the severity and onset, PEM can be of kwashiorkor and Marasmus.

Kwashiorkor occurs due to inadequate intake of proteins or energy ratio. (Fig 1.1)

Marasmus occurs due to inadequate intake of both protein and energy. (Fig 1.2)

CLINICAL FEATURES:

Difference between marasmus and kwashiorkor mentioned in table no: 3

Table 3: difference between marasmus and kwashiorkor

Criteria

Marasmus

Kwashiorkor

Appearance

Old man appearance, skin and bones, generalized wastingLoss of buccal pad of fat creates aged look referred to as monkey facies

Baggy pant appearance refers to loose of skin of the buttocks hanging down

Mooning of face, dependent oedema, upper limb wasted referred asFat sugar baby appearance

age-group

Infants

1-5years

Prevalence

Common

rare

Weight

Less than 60%

60-80%

growth retardation

Present

Mild

Oedema

Nil

Present

Mood

Usually alert

Irritable

Appetite

Good

very poor

Hair changes

nil/mild

Flag sign- alternate bands of hypo pigmented and normally pigmented hair

Skin changes

nil/mild

Increased pigmentation, desquamation, dyspigmentation resembling flaky paint

Infections

Less prone

More prone

Recovery

Early to recover

Long to recover

PREVENTION:

Promote early contact between mother and child

Promote correct breast feeding

Appropriate micro nutrient rich complementary food at 6 months of age

Identify children at risk of PEM and provide adequate social and health support

Basic health facilities to children to prevent infection

GENERAL MANAGEMENT

Daily intake of at least 150 kcal/kg/day

Frequent and appropriate feeding

Protein intake of 3g/kg/day

Include milk, oil and vegetables in diet

HOMEOPATHIC MANAGEMENT

Biochemic remedies

According to Dr. Schussler’s theory, any disturbance in the in the molecular motion of these cell salts in living tissues, caused by a deficiency in the requisite amount, constitute disease, which can be rectified and requisite equilibrium re-established by administering the same mineral salts in small quantities.

Calc-carb: Marasmus, defective nutrition, voracious appetite, swollen abdomen, craving for indigestible things, delayed dentition and learning to walk. Rapid emaciation with harsh and dry skin, unhealthy skin, the debility and irritable.

Calc-phos: Children anemic, emaciated and unable to stand. Large heads, defective bony development, open fontanelles and suture remain open too long, weak spine, curved, thin neck. Delayed teething and slow in learning to walk, Sallow complexion, sunken and flabby abdomen.

 Mag-carb: Emaciation more marked in the back of head. Sallow complexion, undigested vomiting; griping and colicky pains; sour green grassy stools, improperly nourished; bloated abdomen and muscles flabby. Mentally irritable, puny and sickly in appearance.

Natrum-mur: Marasmus from defective nourishment, thin neck, ravenous appetite, losing of flesh while living well. Throat and neck of children emaciate rapidly during summer complaints. Craving for salty food and salt.

Silicea: Deficient and impaired nutrition, imperfect assimilation; rachitic and scrofulous child with large head open fontanelles and sutures, offensive sweat, distended abdomen and weak ankles; late learning to walk; late dentition.

Dynamized medicines:

Abrotanum: Marasmus of children with marked emaciation, especially of legs, skin is flabby and loose in folds, ravenous hunger, losing flesh while eating well.

Iodum: profound debility and great emaciation, ravenous hunger; eats freely and well, yet loses flesh all time, distended abdomen full of gas.

Tuberculinum: physically weak, emaciation of whole body which is rapid and highly pronounced; lose of flesh while eating well.

Sulphur: scrofulous children; emaciated and pot bellied, baby has dirty and filthy look, weak, tall, stoop shouldered and suffers from morning diarrhea.

Sarsaparilla: great emaciation; skin becomes shriveled or lies in folds.

Sanicula: emaciation; progressive; child looks old, dirty greasy and brownish, skin about neck wrinkled and hangs in folds.

 

BIBLIOGRAHY:

  1. GHAI Essentials of Pediatrics, 7th edition, CBS publishers and distributors Pvt.Ltd.
  2. Achar’s textbook of Pediatrics, 4th edition
  3. E Elizabeth, Nutrition and Child Development
  4. Park’s textbook of preventive and social medicine, 24th edition, Banarsidas Bhanot publishers.
  5. Allen H.C.; Keynotes Rearranged and Classified with leading remedies of the Materia Medica and Bowel Nosodes including reportorial index, 10th edition, B. Jain publishers (p)Ltd.
  6. Boericke & Dewey; The Twelve Tissue Remedies of Schussler comprising of The Theory, Therapeutic Application, Materia Medica & A Complete Repertory of Tissue Remedies, 6th edition, Jain publishers(p)Ltd.
  7. William Boericke, Pocket manual of Homeopathic Materia Medica & Repertory, 9th edition, Jain publishers (p)Ltd.
  8. K. Dubey, Text book of Materia Medica, 1st edition, Arunabha Sen Books and Allied (p) Ltd.
  9. DT Bhutia-Journal of Family Medicine Primary Care, 2014- ncbi.nlm.nih.gov

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Dr.Hanoona siddiq
Author: Dr.Hanoona siddiq

Intern Father Muller Homeopathic Medical College and Hospital

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