Kwashiorkor, when the child's hair turns yellowish due to malnutrition

Children need adequate nutrition to support growth and development, including at the age of five. No wonder children have high nutritional needs. However, this high need for nutrients is sometimes not in line with the fulfillment of nutrition for children. As a result, children can suffer from malnutrition. There are various types of malnutrition in children, one of which is kwashiorkor. The following is an explanation of kwashiorkor.

What is kwashiorkor?

Quoting from a book entitled Kwashiorkor from NCBI, kwashiorkor is a disease characterized by malnutrition or a very severe protein deficiency.

This condition usually affects infants and young children and occurs most frequently in children 2-5 years of age when they are weaned.

Kwashiorkor is known as edematous malnutrition . Kwashiorkor is a condition when the child looks fat, due to the buildup of body fluids, especially in the ankle and stomach area.

In fact, the rest of the body is very thin and very deficient in nutritional intake.

Physically, this health problem is different from marasmus whose child is very thin.

Kwashiorkor can be seen in cases of severe hunger and in poverty-stricken areas around the world.

Even in 1950, the disease was recognized as a public health crisis by the World Health Organization or WHO.

History records, in that year children experienced diarrhea, coughing, and shortness of breath. These findings lead to the conclusion that kwashiorkor is the leading cause of death in children.

Even so, the admission is a little late because the children have become victims to death, due to the digestive system that is together and infected.

Since then, efforts to eradicate kwashiorkor began.

Kwashiorkor epidemic area

Still from Kwashiorkor's book, the region most affected by this disease is Central America. Southeast Asia, Congo, South Africa, Uganda, Puerto Rico and Jamaica.

The number of people with kwashiorkor varies, but most of them are seen when the child is experiencing a period of hunger.

What causes kwashiorkor?

Nutritional disorders and eating problems in children can be affected by several things. The following are the causes of kwashiorkor that need attention, namely:

Lack of protein

Children can experience kwashiorkor because they lack a very low protein intake for a very long time.

In fact, every cell in your body contains proteins which are used to repair damaged cells and form new cells. A healthy human body regenerates cells continuously.

If the body is deficient in protein, normal body growth and function will begin to become stunted and this malnutrition can occur.

Difficulty getting food

Limited food supplies often occur in developing countries during times of famine caused by natural disasters, such as drought or floods, even during political unrest.

Lack of knowledge about nutrition can also cause this condition.

Congenital conditions

Genetic factors can affect children experiencing kwashiorkor, for example congenital heart disease which can make a child's food intake unbalanced.

This condition can complicate the process of absorption of nutrients in children.

Symptoms of a child with kwashiorkor

When the condition for protein deficiency is more severe, there are several signs of abnormalities that indicate the child has kwashiorkor.

Here are among them, launching from DermNet:

• Failure to thrive (no gain in height and weight)
• Hair discoloration and texture become reddish yellow (rust color) and dry, brittle or fall out
• Changes in skin pigment, visible rash (dermatitis)
• Limp and pale
• Loss of muscle mass
• Diarrhea
• Edema (swelling) of the ankles, feet, and stomach
• A damaged immune system, which can lead to more frequent and severe infections
• Easy to get angry
• Shock
• Fatty heart

The above conditions are signs or symptoms of kwashiorkor that need to be watched out for

Why is the kwashiorkor child's hair yellow?

Changes in skin and hair color in kwashiorkor children occur for several days after the child is malnourished, how can that happen?

This is caused by changes in the pigment of the hair that becomes dry. This then makes it change color to reddish yellow even to white.

In addition to changing color, kwashiorkor children's nails are also very brittle that they can be pulled out easily. The fingers and toes are soft, dry, and cracked.

The skin of the kwashiorkor child also becomes darker, drier, until it cracks when stretched like a crack in the skin.

How is kwashiorkor diagnosed?

If your child has some of the symptoms of this disease, the doctor will first carry out a physical examination.

Some of the aspects examined are body weight, height plus an enlarged liver (hepatomegaly) and swelling of the body.

In addition, a physical examination is also carried out to look for skin rashes and the condition of the child's feet, hands, face and arms.

Furthermore, blood tests and urine tests are needed to measure the levels of protein and sugar in your child's blood.

This test can look for muscle damage and assess your child's kidney function, overall health, and growth status.

Quoted from Medlineplus, the laboratory tests in question include:

• Arterial blood gases
• Blood Urea Nitrogen (BUN)
• Blood creatinine levels
• Blood potassium levels
• Urinalysis
• Iron in the body
• Complete blood count (CBC)
• Magnesium levels
• The total amount of protein in the body

The doctor will also check the description and history of the child's diet and diet for further diagnosis.

Children who have kwashiorkor tend to have low blood sugar, protein, sodium, and magnesium levels.

Medicine and care of children with kwashiorkor

Most children who have kwashiorkor recover completely if they are treated early. Treatment is done by adding extra calories and protein to the diet.

Children with kwashiorkor may not grow or develop properly and may remain stunted until they are older.

In Kwashiorkor's book, there are 10 main principles that are used globally for kwashiorkor child care.

Here are 10 principles of child care with kwashiorkor, based on the Handbook for Child Health Services:

1. Prevent and treat hypoglycemia

Most children who suffer from malnutrition, including kwashiorkor, experience hypoglycemia.

This is a condition of low blood sugar levels, so the child should be given a glucose solution as much as 10 percent after being admitted to the hospital.

Care

• Immediately give F-75 (special milk for malnourished children) or modification thereof whenever possible.
• If the first F-75 is not provided quickly, give 50 ml of glucose solution orally or via NGT.
• Continue giving F-75 every 2-3 hours, day and night for a minimum of two days.
• If you are still breastfeeding, continue breastfeeding outside the F-75 schedule.
• If the child is unconscious, give a 10 percent glucose solution by injection of 5 ml / kg or 50 ml of granulated sugar solution by NGT.
• Give antibiotics.

Monitoring

If the initial blood sugar level is low, repeat the measurement after 30 minutes, provided that:

• Sugar level below 3 mmol / L (-54 mg / dl), repeat the administration of glucose solution.
• Rectal temperature (measurement of temperature through the anus) is less than 35.5 degrees Celsius and deteriorating health, hypoglycemia caused by hypothermia.

2. Prevent and treat hypothermia

Quoting from WHO, children who are severely malnourished are very susceptible to hypothermia.

This is a condition where the body's core temperature falls below the normal temperature required by the body. Children are said to be hypothermic when their body temperature is less than 35 degrees Celsius.

Severe malnutrition affects an estimated 19 million children under 5 years of age worldwide. It is estimated that it causes the death of about 400 thousand children each year.

Care

• Feed the F-75 immediately.
• Make sure the child's body is warm by wearing a blanket or cuddling with the mother. When using an electric light, place a 40 watt incandescent lamp at a distance of 50 cm from the body.
• Give antibiotics.

Monitoring

• Take the child's temperature every two hours.
• Make sure the child is covered with clothes or blankets, especially at night.
• Check sugar levels if hypothermia is found.

Prevention

• Place the bed in a warm area, in a wind-free part of the room.
• Change wet clothes and bed linen, keep the child's area dry.
• Avoid children from cold atmosphere (such as after bathing or medical examination).
• Let the child sleep cuddled by their parents to keep them warm.
• Feed the F-75 or its modification every two hours.

3. Treat and prevent dehydration

Described on the official WHO website, dehydration in malnourished children such as kwashiorkor is difficult to identify because many signs intersect with other diseases, such as acute diarrhea.

The levels of dehydration usually range from mild, moderate, and severe. This needs to be known to be adjusted to the initial treatment of children with kwashiorkor conditions.

Care

• Use the infusion for rehydration only in cases of severe dehydration with shock.
• Give ReSoMal (special fluids for people with malnutrition, diarrhea, and dehydration) orally or via NGT.
• ReSoMal is given at a dose of 5 ml / kg every 30 minutes for the first 2 hours.
• After two hours, administer ReSoMal 5-10 ml / kg / hour alternating with the same amount of F-75, every hour for 10 hours.
• Give up the F-75 regularly every 2 hours.
• If you still have diarrhea and dehydration, give ReSoMal every time you have a bowel movement. For children less than 1 year old, the dose is 50-100 ml and 100-200 ml for children over one year.

Monitoring

Some of the checks in the monitoring phase are:

• Breath rate
• Pulse frequency
• Micturition frequency and urine volume
• Frequency of bowel movements and vomiting

If the hydration process goes well, the child will experience the child's tears begin to return, the mouth is wet, and the sunken eyes are reduced.

If there are signs of fluid overload, such as increased breath rate 5x per minute and pulse rate 15x per minute, stop giving ReSoMal and immediately reassess it after one hour.

Prevention

• Continue breastfeeding.
• Give fluids F-75 as soon as possible.
• Give ReSoMal 50-100 ml per defecation in liquid form.

4. Improve electrolyte imbalance

Children who are malnourished, such as kwashiorkor, have potassium and magnesium deficiencies which disrupt electrolyte balance.

The Hospital Care for Children website explains that improving the condition takes 2 weeks or more. Edema or swelling of the legs and stomach can result from a deficiency of potassium and magnesium.

To overcome electrolyte disturbances, given potassium and magnesium which are contained in the mineral-mix solution and added to milk F75.

Care

• Give potassium and magnesium which are contained in the mineral mix solution and have been added in F-75, F-100, or ReSoMal.
• Use the ReSoMal solution for rehydration.
• Prepare food without adding salt.

For the monitoring and prevention of electrolyte deficiency, the steps are the same as for the dehydration section.

5. Prevent infection

Data from WHO explains that malnutrition, including kwashiorkor, is very deadly when it has contracted infections such as measles, malaria, and diarrhea.

So it is very important to prevent infection in the care of kwashiorkor children so that they can be saved. Infection reduces the immune system and worsens the nutritional status of the child.

It is very important to give measles vaccine to children with malnutrition as a treatment step. However, this can be postponed if the child is in shock.

Malnourished children are deficient in vitamins and minerals. Although anemia is often found, avoid giving iron in the early stages because it can aggravate the infection. Wait until the child's appetite improves and the child's weight increases.

Care

Give each day for at least two weeks:

• Multivitamins
• Folic acid (5 mg on the first day and thereafter 1 mg / day)
• Zinc 2 mg
• Vitamin A (given orally)

6. Fix micronutrient deficiencies

Children who suffer from kwashiorkor need adequate intake of micronutrients. It requires a lot of vitamins and minerals to meet nutritional needs.

Various vitamins and minerals needed are calcium, iron, zinc, vitamins A, D, E, and K.

7. Early feeding

In the early feeding phase, it must be given with care because the child's physiology is still fragile. Following are the treatments:

• Eat small amounts but often with a low-lactose diet
• Give orally or by NGT
• Energy: 100 kcal / kg / day
• Protein: 1-1.5 grams / kg / day
• Fluid: 130 ml / kg / day (if there is severe edema, give 100 ml / kg / day)
• Fill the number of F-75s as required
• In children with good appetite without edema, the above schedule can be shortened to 2-3 days.

Monitoring

Things to monitor and record on a daily basis in the early feeding phase:

• Amount of food given and spent
• Gag
• Stool frequency and consistency
• Child's weight

8. Enter the growth stage and catch up

The sign that the kwashiorkor child is entering this phase is that the child's appetite has returned and the edema is decreasing.

Care

Make a gradual transition from the original formula (F-75) to the catch-up formula (F-100). Following are the transition phases:

• Replace F 75 with F 100. Give F-100 the same amount as F-75 for 2 consecutive days.
• Next, increase the number of F-100 by 10 ml each time until the child is unable to spend or is left a little.
• Usually this happens when the formula reaches 200 ml / kgBW / day. Can also be used porridge or complementary foods modified so that the energy and protein content is comparable to F-100.
• After the gradual transition, give the child frequent, unlimited feedings (according to the child's abilities). For example, energy: 150-220 kcal / kgBB / day and protein: 4-6 g / kgBB / day.

9. Provide sensory stimulation

After going through a period of treatment, kwashiorkor children need to be given stimulation and emotional support to the child. The conditions are different, it can make him insecure and do not want to socialize with his friends.

Here are some things you can do:

• Expressions of affection
• Cheerful environment
• Structured play therapy for 15-30 minutes
• Physical activity after the child is healthy enough
• Involve parents (father and mother) in every activity
• Prepare toys that are appropriate for their age

The various methods above are used to improve the social and emotional development of early childhood in kwasiorkor children.

10. Prepare to go home

If a kwashiorkor child is more than -2 SD or equivalent to 80 percent, the child is considered to have recovered.

The child may still be underweight because of their short stature. However, it can be given stimulation and good feeding at home.

Complete basic or repeat immunizations and participate in a vitamin A program every February and August.

Complications of kwashiorkor

As mentioned earlier, children with kwashiorkor conditions can experience complications if not treated properly. Here are some of the complications that can occur:

• Swelling of the liver (hepatomegaly)
• Cardiovascular system damage
• Urinary tract infection
• Digestive tract disorders (including pancreatic atrophy, lactase deficiency, bacterial growth)
• Loss of immune function
• Decreased insulin levels (endocrinopathy)
• Metabolic disorders and hypothermia
• Electrolyte abnormalities

With proper care, children who experience kwashiorkor can return to health. It should be noted that delayed and irregular treatment can lead to physical and mental health problems for children.

Many kwashiorkor chicks do not grow to their age due to malnutrition at an early age. If not treated properly, this condition can lead to death.

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