Protein Energy Malnutrition In Under Five Children And It’s Homeopathic Management

ABSTRACT

Protein Energy Malnutrition – PEM is a range of pathological conditions arising from coincident lack, in varying proportion, of protein and calories occurring most frequently in young children and infants and commonly associated with infection. This article reviews about types of malnutrition, classification, indicators, epidemiology, clinical features, prevention, general management and its homeopathic management.

KEYWORDS

Protein energy malnutrition, kwashiorkor, marasmus, homeopathic management

ABBREVIATION

PEM-Protein Energy Malnutrition, WHO-World Health Organization

INTRODUCTON

Protein energy malnutrition can be defined as the impaired growth primarily due to inadequate intake food. Deficiency can be in both macronutrients and micronutrients.it is most wide spread condition affecting health of children, it makes the child more susceptible to infection, recovery is slower and mortality is higher and these children shall have reduced physical and mental health.

EPIDEMOLOGY

The prevalence of stunting among under five children India is 48% and wasting is 20% and with an underweight prevalence of 43%, it is highest in the world.

DETERMINANTS OF PEM

Environmental factors including the physical and social environment, behavioral factors, healthcare services related, biological factors and socio cultural factors including improper feeding technique and nutritional status of the mother.

CLASSIFICATION

Table1:WHO classification of malnutrition based on mid-arm circumference

Normal	13.5cm-16cm
Mild to moderate	12.5cm-13.4cm
Severe	Less than12.5cm

INDICATORS

Table2: Indicators of PEM

Indicators	Interpretations
Stunting	low height for age	Chronic malnutrition
Wasting	Low weight for age	Acute malnutrition
Under weight	Low weight for height	Combination of both acute and chronic malnutrition

 

TYPES

Based on the severity and onset, PEM can be of kwashiorkor and Marasmus.

Kwashiorkor occurs due to inadequate intake of proteins or energy ratio. (Fig 1.1)

Marasmus occurs due to inadequate intake of both protein and energy. (Fig 1.2)

CLINICAL FEATURES:

Difference between marasmus and kwashiorkor mentioned in table no: 3

Table 3: difference between marasmus and kwashiorkor

Criteria	Marasmus	Kwashiorkor
Appearance	Old man appearance, skin and bones, generalized wastingLoss of buccal pad of fat creates aged look referred to as monkey facies Baggy pant appearance refers to loose of skin of the buttocks hanging down	Mooning of face, dependent oedema, upper limb wasted referred asFat sugar baby appearance
age-group	Infants	1-5years
Prevalence	Common	rare
Weight	Less than 60%	60-80%
growth retardation	Present	Mild
Oedema	Nil	Present
Mood	Usually alert	Irritable
Appetite	Good	very poor
Hair changes	nil/mild	Flag sign- alternate bands of hypo pigmented and normally pigmented hair
Skin changes	nil/mild	Increased pigmentation, desquamation, dyspigmentation resembling flaky paint
Infections	Less prone	More prone
Recovery	Early to recover	Long to recover

PREVENTION:

Promote early contact between mother and child

Promote correct breast feeding

Appropriate micro nutrient rich complementary food at 6 months of age

Identify children at risk of PEM and provide adequate social and health support

Basic health facilities to children to prevent infection

GENERAL MANAGEMENT

Daily intake of at least 150 kcal/kg/day

Frequent and appropriate feeding

Protein intake of 3g/kg/day

Include milk, oil and vegetables in diet

HOMEOPATHIC MANAGEMENT

Biochemic remedies

According to Dr. Schussler’s theory, any disturbance in the in the molecular motion of these cell salts in living tissues, caused by a deficiency in the requisite amount, constitute disease, which can be rectified and requisite equilibrium re-established by administering the same mineral salts in small quantities.

Calc-carb: Marasmus, defective nutrition, voracious appetite, swollen abdomen, craving for indigestible things, delayed dentition and learning to walk. Rapid emaciation with harsh and dry skin, unhealthy skin, the debility and irritable.

Calc-phos: Children anemic, emaciated and unable to stand. Large heads, defective bony development, open fontanelles and suture remain open too long, weak spine, curved, thin neck. Delayed teething and slow in learning to walk, Sallow complexion, sunken and flabby abdomen.

 Mag-carb: Emaciation more marked in the back of head. Sallow complexion, undigested vomiting; griping and colicky pains; sour green grassy stools, improperly nourished; bloated abdomen and muscles flabby. Mentally irritable, puny and sickly in appearance.

Natrum-mur: Marasmus from defective nourishment, thin neck, ravenous appetite, losing of flesh while living well. Throat and neck of children emaciate rapidly during summer complaints. Craving for salty food and salt.

Silicea: Deficient and impaired nutrition, imperfect assimilation; rachitic and scrofulous child with large head open fontanelles and sutures, offensive sweat, distended abdomen and weak ankles; late learning to walk; late dentition.

Dynamized medicines:

Abrotanum: Marasmus of children with marked emaciation, especially of legs, skin is flabby and loose in folds, ravenous hunger, losing flesh while eating well.

Iodum: profound debility and great emaciation, ravenous hunger; eats freely and well, yet loses flesh all time, distended abdomen full of gas.

Tuberculinum: physically weak, emaciation of whole body which is rapid and highly pronounced; lose of flesh while eating well.

Sulphur: scrofulous children; emaciated and pot bellied, baby has dirty and filthy look, weak, tall, stoop shouldered and suffers from morning diarrhea.

Sarsaparilla: great emaciation; skin becomes shriveled or lies in folds.

Sanicula: emaciation; progressive; child looks old, dirty greasy and brownish, skin about neck wrinkled and hangs in folds.

 

BIBLIOGRAHY:

1. GHAI Essentials of Pediatrics, 7^th edition, CBS publishers and distributors Pvt.Ltd.
2. Achar’s textbook of Pediatrics, 4^th edition
3. E Elizabeth, Nutrition and Child Development
4. Park’s textbook of preventive and social medicine, 24^th edition, Banarsidas Bhanot publishers.
5. Allen H.C.; Keynotes Rearranged and Classified with leading remedies of the Materia Medica and Bowel Nosodes including reportorial index, 10^th edition, B. Jain publishers (p)Ltd.
6. Boericke & Dewey; The Twelve Tissue Remedies of Schussler comprising of The Theory, Therapeutic Application, Materia Medica & A Complete Repertory of Tissue Remedies, 6^th edition, Jain publishers(p)Ltd.
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8. K. Dubey, Text book of Materia Medica, 1^st edition, Arunabha Sen Books and Allied (p) Ltd.
9. DT Bhutia-Journal of Family Medicine Primary Care, 2014- ncbi.nlm.nih.gov

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