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How to recognize the signs that the child is malnourished

How to recognize the signs that the child is malnourished

The growth process is complex and involves genetic, endocrine, nutritional and psychosocial aspects. However, it is generally possible to recognize and predict a pattern of linear growth and weight gain during childhood and adolescence. Monitoring the growth and health of children and adolescents through nutritional status assessment is an essential tool for the prevention and diagnosis of nutritional disorders such as malnutrition. However, it is important to note that some specific nutritional deficiencies can occur without immediate anthropometric impairment, and their detection depends on careful nutritional history. The isolated or combined deficiency of micronutrients can be identified and confirmed using dietary, clinical and biochemical methods, which are also part of the nutritional status assessment. Therefore, in order to adequately diagnose the nutritional condition, it is necessary to take into account not only the obtaining and interpretation of the anthropometric measures, but the clinical and nutritional history, the physical examination carried out in a detailed way, in search of clinical signs related to nutritional disorders and The most commonly used anthropometric measures in the pediatric age group are weight, height, head circumference and waist circumference, which are measured during the physical exam. Although they are simple procedures, they should be applied carefully, followed by standardization, and the instruments used for their measurement should be frequently calibrated.

Anthropometric references, also called growth curves, are instruments used in practice to assess normality, or abnormality of body measurements such as height, length, weight, arm circumference, circumference of the abdomen, skin folds among others. These curves reproduce, for each age and sex, the different values ​​estimated as normal of each body measurement based on those observed in samples of children and adolescents considered as normal and healthy. In addition to the variation considered normal in each age and sex, these curves present a trend of evolution of these measures as a function of age.

The deviation from this normal pattern of linear growth and weight gain may be the first manifestation of a great variety of clinical conditions. It will therefore be the systematic monitoring of the growth and monitoring of the health and nutritional conditions of children and adolescents together with other clinical elements that will allow us to diagnose malnutrition and to differentiate from patterns considered variants of normality.

Malnutrition is a result of malnutrition, a consequence of the scarcity of both macro and micronutrients, often associated with infectious processes and that can lead to thinness or low weight and chronically to short stature or nutritional dwarfism. It differs in primary malnutrition, when it is of nutritional origin, and secondary when it is generated by non-nutritional diseases that result in the catabolism of protein, carbohydrate and fat reserves.

In addition to weight and height below expected for sex and age, other aspects of the clinical examination may corroborate the diagnosis of malnutrition. Increased frequency of infectious pictures of both the respiratory tract and gastrointestinal tract. The hair can be thin, opaque and brittle. The mucous membranes may appear pale and the skin with a thin appearance is slow in the healing process. Still the child can be show apathetic, sleepy or with less disposition for practice of games or other physical activities. Abdominal distension may occur due to enlarged liver and / or distention of intestinal loops with increased gas production due to food intolerance secondary to malnutrition. The intensity and frequency of these signs and symptoms are directly related to the severity of malnutrition. It should be noted that the greater the inadequacy of weight and height, and thus the more distant values ​​considered normal for age and sex, the greater the risk of these symptoms being present. Therefore, routine and sequential evaluation of child and adolescent growth as well as dietary practices not only for immediate health but for the prevention of chronic diseases in adult life is of paramount importance.References

Nutrition assessment of children and adolescents - Guidance Manual / Brazilian Society of Pediatrics. Department of Nutrology. São Paulo: Brazilian Society of Pediatrics. Department of Nutrology, 2009.

Fernandes BS, Fernandes MT, Bismarck EM, Albuquerque MP. Clinical and preventive approach, book 3. Collection overcoming malnutrition. São Paulo: Salus, 2002.


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