January 11, 2011

Prevention and treatment of protein-energy malnutrition

Prevention and treatment 
Because PEM has been found to occur in early infancy in developing countries where breast-feeding is no longer common, mothers should be encouraged to breast-feed The feeding of the sick child is also an important factor in the prevention of PEM. It is the cultural practice in many areas to feed the child with diarrhea or other infectious disease a very limited diet, often consisting of a thin gruel, such as rice or barley water. Because these illnesses tend to be frequent and severe among children living in poverty with poor housing and unsanitary condi­tions, the dietary treatment is extremely important, and mothers need to be made aware of the increased nutri­tional needs during these periods. If possible, the infant should be fed his usual diet of breast milk and other soft bland foods. Because loss of body fluids during diarrhea may be the most critical factor, he should be given addi­tional water that has been boiled, with perhaps barley or rice to make a very thin gruel.
In the absence of adequate amounts of animal milk, the availabil ty of appropria te "weaning food" C those foods that will replace breast milk) is critical to the prevention of malnutrition in the toddler and the preschool child. Cereal and legume mixtures are relatively bulky foods for their amount of calories and proteins, and young children may not be able to consume large enough quantities of them to meet their needs if other sources of calories and proteins are not also included in the diet. Due to the bulk of these foods and the small capacity of the child's stom­ach, frequent feeding is an important aspect of nutritional care. Four or five meals per day for the child rather than one or two, which may be the common adult practice, is advisable. Moreover, additional, more concentrated sources of both energy and proteins should be added. Starches, tubers and roots, other vegetables, and fruits can contribute additional calories as well as essential vitamins and minerals. Small amounts of eggs, meat, fish (includ­ing fish protein concentrate), unfortunately considered inappropriate foods for children by some cultures, would add good-quality protein to the child's diet. Peanuts (ground nuts) and soy bean products can also provide good sources of high-quality protein. Of course, if milk is available and tolerated, the young child should receive generous amounts of it. Because fresh milk is easily con­taminated with harmful bacteria which grow readily in it, it should be pasteurized or boiled for the young child.
In some developing countries, especially in urban areas, a processed, protein-rich mixture is available as a substitute for milk as a weaning food. The problem, however, is that although this food may cost less than milk or meat, it does usually cost more than the cereals it replaces and, as a result, it is often more expensive than the lowest income groups can afford to purchase in sufficient quantities for child feeding.  This mixture, called Incaparina, consists of cornmeal and de­fatted cottonseed or soy flour with added vitamins and minerals and is available in several Central American countries.
Generous amounts of good-quality protein are required for the treatment of kwashiorkor, milk or a protein-rich milk substitute is essential. Specific dietary treatment depends on the severity of the disease and other deficiency symptoms that may be present. The child may be too sick in the beginning to consume more than small, frequent feedings of relatively dilute mixtures of milk or other formula. As his condition improves, he ,will be able to take larger quantities of more concentrated mixtures.

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