The World Health Organization defines malnutrition as "the cellular imbalance between supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance, and specific functions."

Protein-energy malnutrition (PEM), first described in the 1920s, is observed most frequently in developing countries but has been described with increasing frequency in hospitalized and chronically ill children in the United States.

It is also the most serious and chronic nutrition problem in the Philippines among pre-school children and based on a nationwide weighing survey done by the Food and Nutrition Research Institute, National Science and Technology Authority, nearly 70 per cent of pre-school children are underweight. Several surveys also showed that the section of the country with the highest prevalence of malnutrition was the Eastern and Western Visayas.

What are the symptoms and signs ?

It is often the mother of the malnourished child who detects poor gain in weight and height and also slowed development of the child. "Failure to grow adequately would be their complaint to us doctors", she explains. "The parents are able to detect such a discrepancy in growth, by comparing the gain in weight and height of their child with other siblings and cousins. The child may actually fail to gain weight adequately, may remain at a static weight or may loose weight."

Apart from the poor gain in weight and height, the malnourished child would be less active and interested in his/her environment than a normal age matched child. The child is said to be apathetic and irritable, and may develop recurrent coughs and colds and also skin infections.

If the child is of school age, his school performance may deteriorate and certainly, his disinterest in games and sports will be glaringly obvious even to the most inexperienced physical trainer.

It has also been found that if malnutrition has been severe and occurred over a prolonged period in a young child, he/she may suffer from some degree of intellectual retardation with the result that the child will not attain his/her full potential, in adult life.

Consequences of Malnutrition

According to one of Capitol Medical Center’s pediatrician Dra. Helena Mutuc, children who are chronically malnourished exhibit behavioral changes, including irritability, poor weight gain and height growth, apathy and decreased social responsiveness, anxiety, and attention deficits. In addition, infants and young children who have malnutrition frequently demonstrate developmental delay or permanent cognitive deficits.

"Children are most vulnerable to the effects of malnutrition in infancy and early childhood" she adds. "Premature infants have special nutritional needs that are not met with traditional feeding recommendations; they require fortified human milk or specially designed preterm formula until later in infancy."

Other consequences which may be attributed to early malnutrition are stunted physical growth, reduced energy to learn and develop, higher incidence of illness and disease and, of course, a higher mortality rate.

Currently, more than half of young children in South Asia have PEM, which is 6.5 times the prevalence in the western hemisphere.

In addition to PEM, children may be affected by micronutrient deficiencies, which also have a detrimental effect on growth and development. The most common and clinically significant micronutrient deficiencies in children and childbearing women throughout the world include deficiencies of iron, iodine, zinc, and vitamin A and are estimated to affect as many as two billion people.

These immune changes predispose children to severe and chronic infections, most commonly, infectious diarrhea, which further compromises nutrition causing anorexia, decreased nutrient absorption, increased metabolic needs, and direct nutrient losses.

Inadequate food intake is the most common cause of malnutrition worldwide. In developing countries, inadequate food intake is secondary to insufficient or inappropriate food supplies or early cessation of breastfeeding. In some areas, cultural and religious food customs may play a role. Inadequate sanitation further endangers children by increasing the risk of infectious diseases that increase nutritional losses and alters metabolic demands.

What is the treatment?

Severe forms of malnutrition, where the weight of the child is less than 60% of the average, needs to be treated in a hospital setting. Milder forms of malnutrition, where the weight of the child is less drastically affected, may be managed in a community setting. The basic principles of treatment are as follows:

1. Correction of dehydration (lack of water) in the child. Oral rehydration solution, properly reconstituted, would be ideal. Some children need intravenous fluid therapy.

2. Screening the child for any infections, by performing the tests prescribed earlier.

3. Intensive nutrition treatment or provision of proper food to the child. Since the body is grossly deficient in protein and calories (energy food), these are provided in a manner the child could absorb and assimilate them. High quality proteins (proteins of good biological value), such as milk and later egg and fish are ideal.

These food items are very gradually fed to the malnourished child. Together with these foods, adequate replacement of vitamins, notably vitamin A and other elements like iron need to be given, in adequate quantities. Once the malnourished child begins to consume these foods and gains weight, he could be managed in a community setting or may be done by local health-care providers.

The less drastically affected children could even be managed at home, with the provision of a diet rich in proteins and calories. Foods that are rich in proteins are milk, fish, chicken, lean meat. Foods rich in calories would be rice, scraped coconut, bread, potatoes and yams.

The child also needs oils and margarine or butter, so as to get the essential fatty acids. Coconut oil is a good source of these and is readily available in most Asian countries.

To put it simply, parents who worry about malnutrition should only bare in mind that going back to the basic grow, glow and go foods is the most essential matter and programs to improve hygiene and sanitation are of crucial importance as well.

Fortunately, even the most severe forms of malnutrition, if detected early and treated promptly, carry a favorable outcome. However, if the process of malnutrition has gone on for a protracted period, where the height too is affected, the possibility is that the final height will be affected to some extent although the child will recover from the immediate complications. Some degree of impairment of the intellectual capacity would be seen too.