eMedicine Specialties > Pediatrics: General Medicine > Nutrition

Malnutrition: Treatment & Medication

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

Treatment

Medical Care

  • Following evaluation of the child's nutritional status and identification of the underlying etiology of the malnutrition, dietary intervention in collaboration with a dietitian or other nutritional professionals should be initiated. Children with edema must be assessed carefully for actual nutritional status because edema may mask the severity of malnutrition. Children with chronic malnutrition may require caloric intakes more than 120-150 kcal/kg/d to achieve appropriate weight gain. The formula for determining adequate caloric intake is: kcal/kg = (RDA for age X ideal weight)/actual weight
  • Additionally, any micronutrient deficiencies must be corrected for the child to attain appropriate growth and development. Most children with mild malnutrition respond to increased oral caloric intake and supplementation with vitamin, iron, and folate supplements. The requirement for increased protein is met typically by increasing the food intake, which, in turn, increases both protein and caloric intake. Adequacy of intake is determined by monitoring weight gain.
  • In mild-to-moderate cases of malnutrition, initial assessment and nutritional intervention may be done in the outpatient setting. A patient with malnutrition may require hospitalization based on the severity and instability of the clinical situation. Hospitalization of patients with suspected malnutrition secondary to neglect allows observation of the interactions between parent/caregiver and child and documentation of actual intake and feeding difficulties. It may also be warranted in cases where dehydration and acidosis complicate the clinical picture. In moderate-to-severe cases of malnutrition, enteral supplementation via tube feedings may be necessary.

Consultations

  • Any child at risk for nutritional deficiency should be referred to a registered dietitian or other nutritional professional for a complete nutritional assessment and dietary counseling.
  • In the United States, children with poor nutrition secondary to inadequate intake should be referred to the appropriate social agencies to assist the family in obtaining resources and providing ongoing care for the child.
  • Other subspecialty referrals are based on findings in the initial evaluation that may indicate a specific cause of inadequate nutrition other than inadequate food intake.

Diet

  • Dietary guidelines were released by the US Department of Health and Human Services and the US Department of Agriculture in 2005.9
  • Protein, energy, and other nutrient requirements vary with age, sex, and activity levels.
  • Following careful assessment of the child's nutritional status, initiate nutritional intervention in collaboration with nutrition support personnel.
  • Children with chronic malnutrition may require caloric intakes in excess of 120-150 kcal/kg/d to achieve appropriate weight gain. The diet must include adequate amounts of protein and other macronutrients.
  • Any micronutrient deficiencies must be diagnosed and corrected to achieve adequate somatic growth and psychomotor development.

More on Malnutrition

Overview: Malnutrition
Differential Diagnoses & Workup: Malnutrition
Treatment & Medication: Malnutrition
Follow-up: Malnutrition
Multimedia: Malnutrition
References
[ CLOSE WINDOW ]

References

  1. WHO. Malnutrition-The Global Picture. World Health Organization. Available at http://www.who.int/home-page/.

  2. Blossner, Monika, de Onis, Mercedes. Malnutrition: quantifying the health impact atnational and local levels. Geneva, Switzerland: World Health Organization; 2005. Environmental Burden of Disease Series. [Full Text].

  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].

  4. Benitez-Bribiesca L, De la Rosa-Alvarez I, Mansilla-Olivares A. Dendritic spine pathology in infants with severe protein-calorie malnutrition. Pediatrics. Aug 1999;104(2):e21. [Medline].

  5. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr. Aug 1999;129(8):1555-62. [Medline].

  6. Heywood AH, Marshall T, Heywood PF. Motor development and nutritional status of young children in Madang, Papua New Guinea. P N G Med J. Jun 1991;34(2):109-16. [Medline].

  7. Martorell R, Rivera J, Kaplowitz H, Pollitt E. Long-term consequences of growth retardation during early childhood. In: Hernandez M, Argente J. Human growth:basic and clinical aspects. Amsterdam: Elsevier Science Publishers; 1992:143-149.

  8. Balint JP. Physical findings in nutritional deficiencies. Pediatr Clin North Am. Feb 1998;45(1):245-60. [Medline].

  9. US Department of Health and Human Services, US Department of Agriculture. Dietary guidelines for Americans, 2005. Washington, DC: US Department of Health and Human Services; 2005. 71.

  10. [Best Evidence] Zeng L, Dibley MJ, Cheng Y, et al. Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial. BMJ. Nov 7 2008;337:a2001. [Medline].

  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].

  13. Scrimgeour AG, Lukaski HC. Zinc and diarrheal disease: current status and future perspectives. Curr Opin Clin Nutr Metab Care. Nov 2008;11(6):711-7. [Medline].

  14. Blecker U, Mehta DI, Davis R, et al. Nutritional problems in patients who have chronic disease. Pediatr Rev. Jan 2000;21(1):29-32. [Medline].

  15. Caulfield LE, de Onis M, Blossner M. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr. Jul 2004;80(1):193-8. [Medline].

  16. Chandra RK. 1990 McCollum Award lecture. Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr. May 1991;53(5):1087-101. [Medline].

  17. de Onis M, Blossner M, Borghi E. Estimates of global prevalence of childhood underweight in 1990 and 2015. JAMA. Jun 2 2004;291(21):2600-6. [Medline].

  18. de Onis M, Frongillo EA, Blossner M. Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bull World Health Organ. 2000;78(10):1222-33. [Medline].

  19. Hay WW Jr, Lucas A, Heird WC, et al. Workshop summary: nutrition of the extremely low birth weight infant. Pediatrics. Dec 1999;104(6):1360-8. [Medline].

  20. Islam S, Abely M, Alam NH, et al. Water and electrolyte salvage in an animal model of dehydration and malnutrition. J Pediatr Gastroenterol Nutr. Jan 2004;38(1):27-33. [Medline].

  21. Kleinman RE, Murphy JM, Little M, et al. Hunger in children in the United States: potential behavioral and emotional correlates. Pediatrics. Jan 1998;101(1):E3. [Medline].

  22. Kleinmann R, Committee on Nutrition. Pediatric Nutrition Handbook. 4th ed. American Academy of Pediatrics; 1998.

  23. Koerner CB, Hays TL. Food allergy: current knowledge and future directions. Immunol Allergy Clin North Am. 1999;19.

  24. Man WD, Weber M, Palmer A, Schneider G, Wadda R, Jaffar S. Nutritional status of children admitted to hospital with different diseases and its relationship to outcome in The Gambia, West Africa. Trop Med Int Health. Aug 1998;3(8):678-86. [Medline].

  25. Muller O, Krawinkel M. Malnutrition and health in developing countries. CMAJ. Aug 2 2005;173(3):279-86. [Medline].

  26. Rosenfield RL. Essentials of growth diagnosis. Endocrinol Metab Clin North Am. Sep 1996;25(3):743-58. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.