Allison schmale 59054563

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Allison schmale 59054563
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Children and Malnutrition

• Allison Schmale, PCV

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Introduction

• Qualifications Bachelor of Science in Nutrition
  and Dietetics from St. Louis University
• Objectives
• Identifying Malnutrition in Children
• Meal Planning for Malnourished Children
• Budgeting for Cost Effectiveness
• Practicing Food Safety

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Protein Energy Malnutrition

• Protein Energy Malnutrition/Undernutrition
  (PEM/U) results from lack of food or an
  infection, causing lack of appetite, often
  occurring in children between the ages of 6
  months and 5 years in developing countries.

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Marasmus

• Marasmus is a type of PEM resulting from long
  term starvation or chronic infections causing
  small food intake.
• A defining sign is a skin pulled over bones
  look to the child with little to no fat present
  along with severe wasting of shoulders, arms,
  buttocks and thighs, and visible rib outlines.
• Wasting Involuntary weight loss and loss of lean
  body mass and fat

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Marasmus, Continued

• Physical Signs of Marasmus
• Thin, wizened face
• Baggy Pants-Loose skin of the buttocks hanging
  and flabby
• Noted Alertness in Children
• No Edema in the lower limbs
• Edema Fluid pooling under the skin because of
  poor nutrition, often in the stomach or
  extremities. Causes a pit or indent when
  pressure is applied.
• Ribs are Very Prominent

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Kwashiorkor

• Kwashiorkor occurs when children get enough food,
  but not enough protein to support proper growth.
  This usually occurs in children from 1-4 years.
• Edema is the main sign that indicates Kwashiorkor
  and helps you to distinguish it from Marasmus.
• Edema may cause the child to look fat and well
  fed
• Edema can be identified, when applying moderate
  pressure for 3 seconds and a definite pit
  results.

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Kwashiorkor, continued

• Physical Signs of Kwashiorkor
• Edema in stomach or extremities.
• Hair changes loss of pigmentation (dark hair
  gets a red or orange tint) and curly hair becomes
  straight and is easily plucked.
• Skin changes sores and patches of darker or
  lighter skin
• Children can become apathetic, miserable, and
  irritable. They often show no signs of hunger
  and it can be difficult to get them to eat
• Not all symptoms always occur, however edema
  usually is there while others are not.

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Marasmic Kwashiorkor

• This is a mix of both types of PEM and the
  general signs are edema along with other signs of
  Kwashiorkor.

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Initial Refeeding

• First any underlying problems must be addressed
• Special care must be taken when refeeding
  severely malnourished children in order to
  prevent refeeding syndrome.
• Refeeding syndrome results from over-aggressive
  introduction of nutrients after chronic
  malnutrition, causing an imbalance of
  electrolytes in the body which can result in
  cardiac and pulmonary complications.
• To avoid refeeding syndrome give moderate
  carbohydrates and adequate electrolytes (as in
  ORS)

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As feeding continues

• Initially the child should have less and less
  diarrhea until it completely goes away
• Edema should begin to go away
• Appetite should return
• Do not allow children to consume huge amounts,
  but rather give them small amounts of nutrient
  dense food frequently
• First introduce carbohydrates and work in other
  food groups like protein and fats and fruit and
  vegetables as the child continues to eat more.
  This is easier on their digestive systems and
  helps their gastrointestinal tract to get back in
  working order.

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Meal Planning for Children

• If severe malnutrition is present, moderate
  amounts of food should be given, beginning with
  carbohydrates and slowly integrating small
  servings of protein, fats, and fruits and
  vegetables given in small, frequent meals.
• It is very important that the children get
  adequate protein. If malnutrition is present
  and severe, the child will not be able to make up
  for their lack of mental development, but
  adequate amounts of protein will help with
  further physical development.

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Meal Planning for Children, continued

• Once the child is getting adequate and consistent
  amounts of food, other deficiencies, like
  kwashiorkor or pellagra, should go away with the
  introduction of the necessary nutrients.
• The most important part of a childs diet is that
  they get enough protein everyday, without protein
  they cannot further development both mentally and
  physically.

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Meal Planning for Children, continued
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Meal Planning For Children, continued

• Notes on Previous Slide
• Carbohydrates do not dominate the plate, it is
  important they are in proportion with other
  nutrients on the plate, especially if the child
  is recovering from severe malnutrition.

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Meal Planning for Children, continued

• Protein takes up at least one third of the plate,
  it should always be present and should not be
  replaced or omitted, avoid dairy here in the
  initial phases of refeeding a severely
  malnourished child because the child has
  difficulty digesting diary initially and dairy
  should be slowly reintroduced into the diet to
  prevent further complications.
• Vegetable servings can be made up of several
  vegetables, the more variety on the plate the
  more nutrients the child will get

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Recipe Analysis for Children

• Standard Menu for Lunch or Dinner
• 1 cup papa
• ¼ cup meroho
• ¼ cup eggs
• While this menu does supply protein and vitamins
  and minerals it can be improved by enriching it
  and adjusting the proportions

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Recipe Analysis for Children, continued

• Improved Menu
• 1 cup papa ½ cup papa made with milk
• ¼ cup meroho ¼ cup spinach, carrots, and onion
• ¼ cup pumpkin, all
  made with minimum salt/Aromat
• ¼ cup eggs 1egg scrambled or hard boiled
  (approximately ½ cup)
• This allows the child to get more nutrition out
  of their meal and supplies all nutrients in
  adequate amounts along with a variety of foods.

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Enriching Foods

• The best way to enrich foods is to add milk or
  eggs because they are a very good source of
  protein and vitamins as well as inexpensive.
• Milk and eggs can be added to breads, papa,
  porridge, and samp.
• Foods, like porridge and bread, can also be
  enriched using pumpkin seeds or beans which add
  protein and calories to foods.

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Enriching Foods, continued

• This enrichment will help the food to be more
  filling and gets more protein into the child.
• When cooking eggs you can also add vegetables to
  the eggs in order to get more vegetable servings
  in a meal.
• If a child is not eating well and is lacking in
  appetite, add extra oil in the food to make up
  for calories lost because of small intake.

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Food Comparisons-Which food is better?

• Carbohydrates
• The less the grain has been processed the better
  it is for you. Ex wheat/brown bread is better
  for you than white bread.
• Rice, in full grain form is, better than papa
  (unenriched) because it too provides protein and
  has not been as processed as the papa.
• Keep to the rule that the whole grains, or the
  closer to it, is better than those that have been
  processed or are white.

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Food Comparisons-Which food is better? continued

• Proteins
• Eggs are one of the best sources of protein
  because the protein in eggs is very biologically
  available (meaning our bodies can use it easily
  with little to no waste)
• Dairy is also a good source of protein, but
  should not be given to children recovering from
  malnutrition initially because the digestive
  system is not ready to digest lactose (the sugar
  in dairy) yet.
• Non-animal sources also supply good protein when
  paired with the right carbohydrate.
• Example beans and rice, peanut butter and bread

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Food Comparisons-Which food is better? continued

• Vegetables and Fruits
• Raw vegetables are best because all of the
  nutrients are still intact
• Vegetables should only be cooked until they are
  just done to avoid overcooking, which destroys
  nutrients
• A minimal amount of oil and salt should be used

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Food Comparisons-Which food is better? continued

• Colorful vegetables are more nutritious than
  others. For example spinach has more nutrients
  than potatoes, pumpkin has more nutrients than
  corn/maize.
• Eat a variety of colors means you are getting
  more variety in the meal because different colors
  represent different nutrients.
• Fruits should be used instead of snack foods like
  simbas or desserts. Fruits also supply a good
  source of fiber and other nutrients

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Food Costing

• With your budget, you have to find out how much
  you can spend on each child per day.
• Then from there you can develop a menu to fit
  your budget for each child.
• Careful planning needs to go into planning the
  menu and the budget needs to be followed exactly
  in order for it to be effective.

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Food Costing, continued

• Tips
• Buy in bulk
• Use standardization of recipes and servings (use
  the same amount every time and give out the same
  amounts for the children)
• Take advantage of complimentary proteins to save
  money by serving meat or eggs every few days and
  beans and papa on other days

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Food Costing, continued

• Grow your own food-have a garden, have layers for
  eggs, have a milking cow for milk, etc
• Buy food locally, from other households and local
  shops because you will save on transport, support
  local businesses in your area, and the vegetables
  will be healthier because they are fresh

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Basics to Food Safety

• Food safety is very important and should be
  practiced every time you handle food.
• There are four simple steps to food safety and
  sanitation
• Clean
• Separate
• Cook
• Chill

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Basics to Food Safety, continued

• Cross contamination is when the harmful bacteria
  on food, cutting boards, utensils, surfaces or
  hands contaminates (or gets onto) another food.
• This is prevented by separating food and by
  keeping your hands, utensils and food handling
  surfaces clean.
• Food preparation puts the foods safety
  completely in your hands, making you responsible
  for preparing quality and safe food to eat.
• This starts with using clean preparation methods
  and cooking food to the right temperatures.
• This starts with proper hand washing.

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Basic to Food Safety, continued

• Unclean surfaces and utensils are often the cause
  of cross-contamination.
• It is especially important to keep raw foods,
  like raw meat, poultry, fish and their juices
  away from other foods.
• Wash cutting boards, surfaces, and countertops
  with hot, soapy water after you prepare each item
  and before moving on to the next.
• This is extremely important when handling raw
  meat, poultry, fish, and seafood.
• Cooking food to a safe temperature is the best
  way to make it safe, to make sure it is safe,
  there are temperatures that food should be cooked
  to, to destroy any harmful bacteria that may be
  in the food.

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Basics to Food Safety, continued

• When serving food
• Keep hot food hot and cold food cold so the food
  doesnt reach a temperature where bacteria can
  grow
• Keep everything clean by washing your hands, wash
  utensils and dishes, keep food separate using
  plastic wrap and sealed containers, bring water
  and soap with you if there is no running water to
  wash things up
• Wash dishes is warm soapy water and allow to sit
  in a solution of 1 tbsp bleach to 2 liters of
  water for a few minutes to ensure all the
  bacteria have been killed and the dishes are safe
  to use

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Recipe Suggestions

• Omelet (for four people)
• 8 eggs (two per person served)
• Tomato, chopped
• Onion, chopped
• Green pepper, chopped
• Spinach, chopped
• Salt and pepper
• 2 tbsp Cooking oil or margarine, or more if
  needed
• Beat eggs and add salt and pepper
• Heat margarine or oil in pan, when hot pour in
  the eggs and stir.
• When the mixture set, tilt the pan back so the
  uncooked portion will flow under the cooked
  portion. Continue this way until all is set and
  has light brown color underneath.
• Add tomato, green pepper, spinach, and onion to
  one half and fold over.
• Serve immediately.

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Recipe Suggestions, continued

• Spinach Fat Cakes
• 4 cups spinach
• 2 ½ cup flour
• 1 tsp Salt
• 2tsp Barbecue Spice
• 2 egg
• Cooking oil
• Chop spinach
• Stir together flour, salt, barbecue spice then
  add eggs and then add spinach.
• Heat oil in a pan and drop about a handful size
  of spinach mixture into pan and fry until golden
  brown on both sides.

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Recipes Suggestions, continued

• Bean Soup
• 2 cups beans
• 1 cup potatoes
• 1cup carrots
• 1 green pepper
• 2 tomatoes
• 1 onion
• 2 tbsp cooking oil
• 2 tsp barbecue spice
• 2 tsp white pepper
• 2 tsp salt
• Water
• Cook beans until they are soft
• Chop carrots, potatoes, tomatoes and green pepper
• Fry onion
• Mix together, and simmer until soft, stirring
  constantly
• Allow to simmer until vegetables are soft

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Recipe Suggestions, continued

• Vegetable soup
• 1 cup potatoes
• 1 cup spinach
• 1 cup carrots
• 2 tomatoes
• 1 tbsp cooking oil
• ½ tsp salt
• Wash, peel and cut up vegetables into small
  pieces
• Cook carrots until soft, then add to vegetable
  mixture
• Simmer until soft
• Serve while warm

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Recipe Suggestions, continued

• Pumpkin Soup
• 2 medium onions
• 1 tbsp flour
• 1 cup milk
• 2 tbsp margarine
• 2 cups chicken broth
• 3 cups pumpkin puree
• Salt and Pepper to taste
• Sautee onions in margarine
• Sprinkle flour over onions, stir and cook for 5
  minutes
• Gradually add chicken broth and milk stirring
  constantly
• Add pumpkin puree and cook on low heat for 15
  minutes
• Add salt and pepper to taste

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Recipe Suggestions, continued

• Sechu (Mixed Vegetables)
• 1 cup spinach
• 1 cup carrots
• 1 cup potato, cooked
• 1 onion, chopped
• 2 tomatoes
• 1 green pepper
• 2 teaspoons barbecue spice
• 2 teaspoons white pepper
• Salt to taste
• Cooking oil
• Cook potato by boiling in water until soft.
• Chop all vegetables into small pieces
• Sautee onion and green pepper in oil, then add
  carrots and cook until soft. Then add all the
  rest of the vegetables and seasonings, toss
  together in pan.
• Take off heat and serve immediately.

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Recipe Suggestions, continued

• Improved Porridge with Egg
• 1 cup sorghum meal
• 1 cup milk
• 1 egg
• 2 cups water
• 2 tsp sugar
• Boil water
• Mix flour with milk and sugar
• Gradually add the milk and egg to mixture, while
  stirring
• Simmer for 15 minutes

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Recipe Suggestions, continued

• Porridge with Milk
• 1 cup maize meal
• 3 cups milk
• Add half cup milk to pan, then add second half
  once brought to boil
• Mix and let simmer
• Cook 20 minutes

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Recipe Suggestions, continued

• Bean Porridge
• 2 tbsp maize meal, sorghum meal or wheat meal
• 1 cup cooked beans or peas
• Water
• Mast the beans or peas, then sieve them
• Cook the soft porridge
• Add sieved beans to soft porridge, then let
  simmer
• Remove from heat, cool

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Sources

• Protein Energy Malnutrition. www.emro.who.int/nu
  trition/pdf/protein_malnutrition.pdf. May 18,
  2009.
• Mahan, L. Kathleen and Stump, Sylvia
  Escott-Stump. Krauses Food and Nutrition
  Therapy. 12 ed. Saunders Elsevier, St. Louis.
  2008.