Nutritional deficiencies also known as Malnutrition is the lack of essential nutrients in the diet or failure of the body to absorb the nutrients. It is a serious health concern especially in children because growth and development can be hindered.
Below are a few of the common nutritional deficiencies and how they present:
Protein and Carbohydrate Energy Malnutrition
This includes conditions such as kwashiorkor or marasmus. It is characterized by inadequate protein and carbohydrate intake. Kwashiorkor is inadequate protein intake with reasonable carbohydrate intake while marasmus is inadequate intake of both protein and carbohydrate.
Symptoms may include:
- Weight loss
- Poor weight gain – for marasmus
- Body swelling – for kwashiorkor
- Lack of energy
- Disinterest in food
Iron helps the body produce red blood cells. It is found in red meat, egg yolk and leafy green vegetables. Iron deficiency can be caused by lack of iron in the child’s diet or conditions such as celiac disease, intestinal blood loss, anemia of chronic disease, etc. When a child’s body is deficient in iron, it produces fewer red blood cells which are smaller and paler and this is termed microcytic anemia. This impairs oxygen delivery to the tissues and organs.
Risk factors include children born in poverty, premature and low birth weight babies, infants fed with non-iron fortified formula, obese children, etc.
Symptoms of iron deficiency in children may include :
- Loss of appetite
- Behavioral problems
- Increased sweating
- Failure to grow
- Recurrent infections
- Strange food cravings like eating dirt
Vitamin D Deficiency
Vitamin D is needed for the absorption of calcium and hence is needed for the development of strong bones. Deficiencies can result in hypocalcemia and hypophosphatemia; low calcium and phosphate levels respectively. This can lead to Rickets in children. Usually children with vitamin D deficiency will be asymptomatic but can present with hyperparathyroidism and changes in growth plates.
It is also known that vitamin D deficiency has a role in immune function other than the calcium metabolism pathway. It is involved in the development of allergies, atopic diseases, tuberculosis and other respiratory infections, autoimmune diseases such as Type 1 diabetes mellitus, asthma and multiple sclerosis.
Risk factors include; prolonged breast feeding without vitamin D supplementation, low sun exposure, breast feeding mothers who are dark skinned or vitamin D deficient.
Calcium is needed to help the body make strong bones and teeth. It also helps the heart, muscles and nerves work. Calcium deficiency does not show symptoms at the start but can lead to serious health problems over a period of time. Calcium is gotten from dairy products such as milk, cheese and yoghurt, kale, broccoli, etc.
Cobalamin (Vitamin B-12 deficiency)
Vitamin B-12 assists the body in making healthy red blood cells. Infants who have cobalamin deficiency is usually as a result of cobalamin deficiencies of breast feeding mothers who follow strict vegan diets, breast feeding mothers who have had gastric bypass and children with malabsorptive syndromes, just to mention a few. These children often present with growth,, development, movement and hematologic problems.
Symptoms may include:
- Weight loss
- Shortness of breath
- Poor appetite
- Sore, red or swollen tongue
- Pale or yellowish skin
Folate (Vitamin B-9 deficiency)
Vitamin B-9 also helps produce red blood cells and DNA. It also helps nervous system functioning. It is very important in fetal development; plays an important role in the formation of a developing child’s brain and spinal cord. Deficiencies can lead to severe birth defects, growth problems or anemia. Folate can be found in beans, lentils, citrus foods, leafy vegetables, meat such as poultry and pork, whole grains, etc.
Thiamine (Vitamin B-1) Deficiency
Thiamine is an important part of the nervous system. It also helps the body convert carbohydrates into energy as part of metabolism. In children, a deficiency is associated with conditions known as Beriberi, Wernicke-Korsakoff syndrome and Leigh syndrome. Infants with beriberi present with cardiomegaly, tachycardia, loud piercing cry, cyanosis, dyspnea and vomiting. They are also at risk of developing aseptic meningitis.
Niacin (Vitamin B-3) Deficiency
Niacin also helps the body convert food into energy. A deficiency results in a condition known as pellagra. Children will present with hyperpigmentation in sun exposed areas, red tongue, diarrhea, vomiting, neurologic symptoms like insomnia, anxiety, dementia, etc.
Vitamin A Deficiency
Vitamin A is needed for eye health and functioning. Children will present with conjunctival dryness, keratin debris on the conjunctiva (Bitot spots), drying of the cornea and night blindness. This can eventually lead to permanent blindness. The child is also susceptible to infections and physical growth is reduced.
Diagnosis of Malnutrition : What to do
Any child with suspected nutritional deficiencies should be taken to see a doctor. A series of blood tests will be done with some physical examinations and history taking.
The blood tests may include:
- Complete blood count
- Thyroid function test
- Serum albumin
- Urine culture and sensitivity
- Urea and electrolytes
Treatment of Malnutrition in children
A doctor may prescribe dietary supplements, advice on diet changes and give other medication to treat any underlying symptoms.
Immunization is also recommended.
How to Prevent Malnutrition
- A well balanced diet should be given to children.
- Pregnant and breast feeding mothers are also encouraged to eat a well-balanced diet.
- Daily vitamin supplements could be given to children.
Standard Treatment Guidelines – Sixth Edition