Malnutrition is a significant public health issue, especially in developing countries like India. It is a leading cause of morbidity and mortality in children under five. Therefore, doctors need to understand the mechanisms, types, and treatment of malnutrition.
Similarly, adequate nutrition is essential for the growth and development of children. Nutrition-related disorders like obesity, anemia, and vitamin deficiencies can have lifelong consequences. Understanding children's nutritional needs at different growth stages is important for preventing and managing these conditions.
This makes both nutrition and malnutrition important pediatrics topics for NExT/NEET PG preparations. In this blog we’ll discuss breast milk and breastfeeding, micronutrients, malnutrition, fluids and electrolytes.
Breast Milk And Breastfeeding
When should breastfeeding be initiated?
As soon as possible after birth or within 1 hr of childbirth
Irrespective of normal vaginal delivery or C-section
Exclusive breast feeding is recommended for how long?
It is recommended for first 6 months of life
Exclusive breast feeding means that baby is given only breast milk, not even sips of water unless medically recommended
After 6 months of age, what should be started?
Complementary feeding: Refers to some semi solid energy dense food that should be affordable, feasible, acceptable, sustainable, safe & that can be given in addition to breast milk
What is the problem if food grains are started at <age 6 months?
More chances of food allergy are seen in babies
Some study linked usage of wheat in <6 months of child to celiac disease
Storage of expressed breast milk can be done for how long?
Depend on temperature of storage:
At room temperature: 8-10 hrs
In refrigerator at 2-8°C: 24 hrs
In deep freezer (-20°C): 3 months
Signs of good positioning while breastfeeding?
Body of baby should be:
Turned towards mother
Occiput, shoulder and buttocks should be in straight line
So close to mother that abdomen of baby should touch abdomen of mother
What are sign of good attachment while breastfeeding?
Related to nipple area of mother and oral cavity of baby:
Mouth of baby should be wide open
Lower lip of baby should be everted or turned out
Whole of areola should be covered by mouth except upper part which may be visible
Chin of baby should touch mother’s breast
What is the contraindication to breast feeding in neonates?
Conditions related to baby: Galactosemia, Congenital lactose intolerance
Maternal condition: Absolute – Mother on chemotherapy or radiotherapy
Infective condition like maternal HIV
In developed countries – C.I
In developing countries – Indicated: Maternal active TB, Varicella involving breast area, Breast abscess
Dehydration: WHO ORS (in double dilution) / Resomal - Rehydration solution for malnourished child (↓Na, ↑K), corrected slowly to prevent overload
Deficiency of Micronutrients
Iron supplementation should be started only in rehabilitation phase not during initial phase
Initially F75: 75 kcal / 100 ml and 0.7 gm of protein
Then F100: 100 kcal / 100 ml
Later RUTF: 543 kcal / 100g (Ready to Use Therapeutic Food).
FLUIDS & ELECTROLYTES
Calculation of 24 hrs. maintenance fluid requirement in children:
First 10 kg: 100 ml / kg
Next 10 kg: 50 ml / kg
Beyond 20 kg: 20 ml / kg
For example: If the weight of a child is 24 kg. How much fluid is to be given in 24 hrs?
For first 10 kg – 10 x 100 = 1000 ml
For first 10 kg – 10x50 = 500 ml
For first 4 kg - 4x20 = 80 ml
So, in first 24 hours – 1580 ml of fluid is given
Fluid of choice – N/2 in 5% dextrose or DNS with 1ml of KCL/100ml
Birth weight >1500 g: Start with 60 ml / kg / day
BW < 1500 g: Start with 80 ml / kg / day
By Day 7 of life: 150 ml / kg / day
1st 48 hours IV fluid of choice: 10 % Dextrose with no electrolytes
>48 hrs: N/5 in 5% dextrose
Management of shock in children
IV fluid boluses – Normal saline preferred; 20ml/kg can be given up to 3 times
If child still in shock – Start inotropes
Dopamine – usually first line
Dobutamine - Given in cardiogenic shock
Non epinephrine – Warm shock
Epinephrine – Cold shock
IV antibiotics – For septic shock or any infection
If shock still present after dopamine is given, it is called catecholamine resistant shock
IV Hydrocortisone given
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