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. [19, 20] 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. [21, 22] 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.
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Hormonal adaptation to the stress of malnutrition: The evolution of marasmus.
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A classic example of a weight chart for a severely malnourished child.
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This infant presented with symptoms indicative of a dietary protein deficiency, including edema and ridging of the toenails. Image courtesy of the Centers for Disease Control and Prevention.
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This infant presented with symptoms indicative of Kwashiorkor, a dietary protein deficiency. Note the angular stomatitis indicative of an accompanying Vitamin B deficiency as well. Image courtesy of the Centers for Disease Control and Prevention.
