eMedicine Specialties > Pediatrics: General Medicine > Nutrition

Malnutrition: Follow-up

Author: Harohalli R Shashidhar, Associate Professor, Department of Pediatrics, Chief, Division of Pediatric Gastroenterology and Nutrition, University of Kentucky Medical Center
Coauthor(s): Donna G Grigsby, MD, Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine
Contributor Information and Disclosures

Updated: Apr 9, 2009

Follow-up

Further Outpatient Care

  • Monitor patients closely for growth and resolution of clinical signs and symptoms of malnutrition. Follow-up should be based on the severity of the illness, age of the patient, and the patient's initial response to intervention.
  • Minimal intervals between visits should give the patient sufficient time to show a change in the measured parameter. For example, in infants beyond the newborn stage, the time needed to show an appreciable change in weight is 7 days. A 4-week interval is needed to document changes in length, and an 8-week interval is needed to document a change in height.

Deterrence/Prevention

  • Prevention of malnutrition in children starts with an emphasis on prenatal nutrition and good prenatal care. Health care providers should emphasize the importance of breastfeeding in the first year of life. Promotion of breastfeeding is particularly crucial in developing countries where safe alternatives to human milk are unavailable. In addition to the promotion of breastfeeding, health care providers should counsel parents on the appropriate introduction of nutritious supplemental foods. Health care providers should continue to provide age-appropriate nutritional counseling at every opportunity.
  • Programs addressing micronutrient supplementation and fortification have been successful at decreasing the incidence of specific micronutrient deficiencies (eg, iodine, vitamin D) in many countries, and supplementation in pregnant women has also been beneficial.10,11 These programs should be promoted more in developing countries. In addition, research demonstrates that zinc supplementation can help reduce the duration and severity of acute and persistent diarrheal illnesses in children in areas where diarrhea is a significant cause of mortality and is recommended by the World Health Organization and UNICEF.12,13 Additional fortification programs should be developed to address other common nutritional deficiencies such as iron deficiency, which continues to be significant problem throughout the world.
  • Improvement in hygiene practices and sanitation reduces the incidence of infectious diseases, which decreases the incidence of malnutrition in developing countries.

Prognosis

  • Children who have chronic malnutrition, especially those with intrauterine growth retardation and with onset at an early age, do not achieve their full growth potential or regain cognitive deficits. Although malnutrition is rare in the United States and other industrialized countries, over half of childhood mortality in developing countries is either directly or indirectly secondary to malnutrition.
 


More on Malnutrition

Overview: Malnutrition
Differential Diagnoses & Workup: Malnutrition
Treatment & Medication: Malnutrition
Follow-up: Malnutrition
Multimedia: Malnutrition
References
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References

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  3. Hendricks KM, Duggan C, Gallagher L, et al. Malnutrition in hospitalized pediatric patients. Current prevalence. Arch Pediatr Adolesc Med. Oct 1995;149(10):1118-22. [Medline].

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  11. [Best Evidence] Roberfroid D, Huybregts L, Lanou H, et al. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. Nov 2008;88(5):1330-40. [Medline].

  12. [Best Evidence] Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. Jul 16 2008;CD005436. [Medline].

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Further Reading

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Keywords

malnutrition, protein-energy malnutrition, PEM, protein-calorie malnutrition, kwashiorkor, marasmus, starvation, hunger, poor diet, nutritional deficiency, diagnosis, treatment, acquired immunodeficiency syndrome, infectious diarrhea, AIDS, hyperaldosteronism, irritability, apathy, decreased social responsiveness, anxiety, attention deficits, mental retardation, hypogonadism, acrodermatitis enteropathica, cheilosis, angular stomatitis, hepatomegaly, cystic fibrosis, chronic renal failure, inflammatory bowel disease, prematurity, allergies

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Contributor Information and Disclosures

Author

Harohalli R Shashidhar, Associate Professor, Department of Pediatrics, Chief, Division of Pediatric Gastroenterology and Nutrition, University of Kentucky Medical Center
Harohalli R Shashidhar is a member of the following medical societies: American Academy of Pediatrics, Kentucky Medical Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: TAP pharmaceuticals Honoraria Speaking and teaching; Salix Honoraria Review panel membership

Coauthor(s)

Donna G Grigsby, MD, Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine
Donna G Grigsby, MD is a member of the following medical societies: American Academy of Pediatrics and Kentucky Pediatric Society
Disclosure: Nothing to disclose.

Medical Editor

Maria Rebello Mascarenhas, MBBS, Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia
Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia
Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Federation for Clinical Research, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Mead Johnson Consulting fee Consulting; Mead Johnson Honoraria Speaking and teaching; Dey LP Consulting fee Consulting; Dey LP Honoraria Speaking and teaching; Ovation Honoraria Speaking and teaching

 
 
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