Marasmus, a condition of malnutrition in children that can cause death

The body needs a variety of nutrients to improve the development of children under five. The condition of lack of nutrition can interfere with the immune system, trigger disease, and even death. Malnutrition that lasts too long is the cause of chronic nutritional problems, one of which is marasmus. What is marasmus?

What is marasmus?

In a journal published by Hindawi entitled Acute Liver Injury with Severe Coagulopathy in Marasmus Caused by a Somatic Delusional Disorder , marasmus is a more severe form of calorie malnutrition.

Marasmus is a condition characterized by a lack of calories and fluids in the body and depletion of fat reserves. This results in the body's muscles shrinking.

Calories are one of the main elements needed to carry out various body functions.

When the body is deprived of calories, various physical functions experience slowdown and even stop.

Marasmus is a common health problem in developing countries and can affect both children and adults.

In children, especially toddlers, this condition is more likely to occur and has a higher severity.

UNICEF wrote on its official website that in 2018, 49 million children under the age of 5 had marasmus. The distribution covers South Asia and Africa with the same proportion.

Lack of protein and calories can also cause kwashiorkor which is a complication of marasmus.

In general, kwashiorkor occurs in children and causes growth problems, especially stunting.

The condition of nutritional deficiencies at the age of five will increase a child's risk of experiencing kwashiorkor.

Marasmus can be recognized by the height and weight of the child

Determination of this condition is carried out by physical examination of the child's height and weight. In children, height and weight will be adjusted according to age limits.

If the child is below normal in height and weight, this is probably an early sign of developing marasmus.

In the Children's Diet Guide book, it is explained that marasmus is included in the group of malnutrition in children.

Poor nutrition is characterized by a body weight less than 70 percent of the average. This is adjusted to the height and length of the body.

Simply put, malnutrition in children occurs when the child's height and weight are in the -3 SD line. If the case is more severe, this figure is below the -3 SD line according to the WHO growth chart.

In addition, the behavior or activity of children can also be a reinforcement of the diagnosis. When children have marasmus, they will look weak and tend not to care about their surroundings.

The difficulty that may occur in recognizing it, especially in children, is to distinguish the initial symptoms of malnutrition from the presence of an infectious disease.

Symptoms of marasmus in children

The main symptom of a child with marasmus is a very drastic weight loss. This decrease is caused by the body losing a lot of subcutaneous fat tissue under the skin and muscle mass in the body.

This condition causes the child's body mass index (BMI) to drop sharply to a very low level. This made him suffer from malnutrition which could not be underestimated.

The reason is, this condition can hinder physical development, cognitive development of children, and mental health.

If the food intake is insufficient for a long time, the stomach will experience shrinkage.

Marasmus is also synonymous with the loss of fat and muscle mass so that someone can look very thin.

In addition, marasmus often begins with hunger and other symptoms of malnutrition, including:

• Fatigue
• Decreased body temperature
• Chronic diarrhea
• Respiratory tract infection
• Emotional disturbance in children or not showing emotional expression
• Easy to get angry
• Sluggish
• Breathing slows down
• Hand shaking
• Dry and rough skin
• Baldness

This very severe condition of malnutrition can make children discouraged, lethargic, and make children emotionally explosive.

What causes marasmus?

Nutritional deficiencies are very much influenced by various things. The causes of marasmus are as follows:

Lack of calorie intake

The main cause of marasmus is a lack of calorie intake. Lack of calories automatically contributes to other nutritional deficiencies.

Nutrients such as carbohydrates, iron, iodine, zinc, and vitamin A are needed by the body to grow and develop. This condition can be triggered by limited access to food needs.

Usually, the lack of energy and protein content in food occurs at the same time. It is also often associated with vitamin and mineral deficiencies.

If you have severe marasmus, your child can experience a combination of malnutrition, namely marasmic kwashiorkor.

Eating disorders

Apart from a lack of nutrition, eating disorders such as anorexia nervosa can also cause marasmus, quoting the book Nutrition for Children and Adolescents.

This is a deviant behavior in the eating process and causes insufficient intake of nutrients the body needs.

Not only anorexia, an eating disorder that can cause marasmus is pica. This is a condition when people eat food that is not edible.

Pica is very dangerous because doctors cannot observe if they are consuming something that should not be eaten.

Eating disorders can cause marasmus if done within a month in children over 24 months of age.

Health status

The child's condition while being treated or experiencing infections such as syphilis and tuberculosis causes the child to need proper nutritional intake in greater amounts.

If not fulfilled, children will easily experience nutritional deficiencies. In addition, the level of knowledge of toddler food nutrition in parents, both father and mother, also causes marasmus in children.

This is what makes your baby's health condition disturbed during his growth. Ignorance of the benefits of exclusive breastfeeding, for example or lack of knowledge about fulfilling children's nutrition.

Congenital conditions

Genetic factors also affect marasmus. For example, congenital or congenital heart disease can affect a child's diet.

This in turn can lead to an imbalance of intake leading to malnutrition. This condition ultimately complicates the process of absorption of nutrients in your little one.

Factors that increase the risk of marasmus

Source: Healthline

It cannot be denied that growing up in developing countries is a risk factor for this one malnutrition.

Children in areas with high poverty rates are more likely to experience marasmus.

In addition, here are the factors that increase the risk of marasmus:

• Mother's milk production is not sufficient because her body is malnourished
• Viral, bacterial and parasitic infections
• Living in an area with high levels of hunger
• Live in an area with high disease rates
• Insufficient medical care

Marasmus is the cumulative result of a lack of nutrients such as protein and calories. Poverty is one of the dominating factors.

How is marasmus diagnosed?

The doctor will perform an initial examination, which is a physical examination that includes height, weight, and the possibility that the child is malnourished.

When the reading is very far from the normal limit for his age, marasmus can be the cause of the condition.

Marasmus can be aggravated by the daily activities of children who are sedentary. This is a sign that the child's energy needs are not being met properly.

Unlike other health conditions that can be diagnosed with a blood test, marasmus cannot be detected this way.

The reason is, children who have marasmus also have an infectious disease that can affect blood test results.

How is the treatment for children who have marasmus?

Marasmus should be treated gradually. There are 10 general handling stages that need to be considered, based on the Handbook of Children's Health of the Indonesian Ministry of Health:

1. Prevent and treat hypoglycemia

Children who are malnourished, including marasmus, are at risk of developing hypoglycemia. This is a condition of low blood sugar levels, so the child must be given food or a sugar solution of 10 percent when admitted to the hospital.

As treatment, children will be given a special formula in the form of F 75 or its modification. It is a liquid that contains:

• 25 grams of powdered skim milk
• 100 grams of sugar
• 30 grams of cooking oil
• 20 ml of electrolyte solution
• 1000 ml of additional water

This formula will be used for every treatment of children with malnutrition, including marasmus.

Care

• Immediately give the formula F 75 to the child
• If not present, give 50 ml of glucose solution orally or NGT
• Continue giving F 75 or glucose solution every 2-3 hours
• If the child is still drinking breast milk, continue breastfeeding outside the time of drinking. F 75
• A 50 ml solution of granulated sugar needs to be given if the child's condition is unconscious

Monitoring

If the child's blood sugar level is low, repeat the blood sugar level measurement after 30 minutes. Here are the conditions:

• The child's blood sugar level is below 3 mmol / L (-54 mg / dl), then the sugar solution is repeated.
• When taking the rectal temperature (rectal temperature) less than 35.5 degrees Celsius, give glucose solution.

Prevention

Give the F 75 formula every two hours to the child, if he looks weak, rehydrate first.

2. Prevent and treat hypothermia

The human body is said to be hypothermic when the body temperature is less than 35.5 degrees Celsius.

Hypothermia is a condition where the body temperature drops below normal temperature and children who are malnourished are at risk of experiencing it.

Care

• Immediately give the formula F 75 solution to the child
• Warm the child's body with a blanket or held it on the chest
• Give antibiotics

Monitoring

• Take your little one's temperature every two hours
• Keep the child's body warm, especially at night
• Check the sugar level to check if the child has hypoglycemia

Prevention

• Keep children's clothes and mattresses dry
• Keep the child away from cold weather
• Create a warm room atmosphere
• Give the formula F 75 or its modification every two hours

3. Treat and prevent dehydration

Dehydration can lead to difficulty digesting food and worsen diarrhea symptoms if your child experiences it.

After starting to get better, treatment is continued by providing a varied diet for toddlers to meet their nutritional needs.

The food given should be high in protein, such as using vegetable oil, casein, and sugar.

Casein is a protein in milk that can increase the calorie content in a child's body.

However, sometimes people with marasmus are unable to eat and drink normally.

Usually eating and drinking is done in small amounts or using an intravenous drip into the vein and stomach.

4. Maintain electrolyte balance

Children with marasmus are deficient in potassium and magnesium. This results in disturbed electrolyte balance in his body.

To treat electrolyte disorders, children need to be given potassium and magnesium in the F 75 formula solution and mineral mix solution.

Here's how to handle it:

Care

• Give the potassium and magnesium contained in the mineral mix solution that has been added to the F-75.
• Give ReSoMal solution for rehydration.

Monitoring

• Monitor respiratory rate.
• Monitor pulse frequency.
• Monitor the amount of urine.
• Monitor the intensity of bowel movements and vomiting.

Prevention

• Continue breastfeeding.
• Give formula F-75 as soon as possible.
• Give ReSoMal 50-100 ml for each child with diarrhea.

5. Prevent infection

If a child with marasmus has an infection, this can worsen their health condition. Infections that can catch such as measles, malaria, and diarrhea.

The three of them make marasmus conditions deadly. It is very important to protect and prevent children from getting infected by providing vitamins and minerals, such as:

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

The vitamins and minerals above can prevent infection.

6. Fix micronutrient deficiencies

Malnourished children, including marasmus, require adequate intake of micronutrients. As for the nutrients needed, such as iron, calcium, zinc, vitamins A, D, E, and K.

7. Early feeding

When the child has entered this stage, there are several things that need to be considered, namely:

• Eat a low-lactose diet in small amounts but often
• Give food by NGT or directly (orally)
• Energy requirements: 100 kcal / kg / day
• Protein requirements: 1-1.5 grams / kg / day
• Fluid requirements: 130 ml / kg / day (severe edema conditions, give 100 ml / kg / day)

These various gifts are carried out under the monitoring of a doctor

Monitoring

The following are things that need to be monitored and recorded on a daily basis at the early feeding stage:

• Amount of food consumed
• There is vomiting or not
• Stool consistency
• Child's weight

This monitoring is carried out by a doctor.

8. Enter the growth stage and catch up

When the child has entered this phase, the sign is that the appetite has returned. You need to make a gradual transition to move from the formula F 75 to F 100.

Here are the details:

• Give F100 the same amount as F75 for 2 consecutive days
• Increase the number of F100 by 10 ml
• Frequent feeding with an unlimited amount (according to the child's ability)
• Energy: 150-220 kcal / kgBB / day
• Protein: 4-6 grams / kg / day

If the child is still getting breast milk, continue with breastfeeding but still make sure the child is getting F100.

The reason is that breast milk does not contain enough energy to support children's chasing growth.

9. Provide sensory stimulation

Children who have marasmus often lack confidence because of their different conditions. After going through all the stages and getting to this phase, you need to provide sensory and emotional stimulation, such as:

• Give an expression of affection
• Creating a cheerful environment
• Play therapy 15-30 minutes per day
• Invite him to do physical activities
• Doing activities together such as eating and playing

Marasmus conditions often make children insecure, so they need emotional support to improve the social and emotional development of early childhood.

10. Prepare to go home

When the child's weight and height are above -2 SD, the child can go home and take care at home.

In addition, other considerations that allow children to go home are:

• Already done antibiotic treatment
• Have a good appetite
• Indicates weight gain
• Edema has disappeared or has reduced dramatically

In addition, infections often occur in children who have marasmus, so antibiotics need to be given.

Treating infections and other health problems can help and give your child a chance to recover more quickly.

How can you prevent marasmus?

If the risk factors for this disease are far from your condition, you still need to take preventive steps. Here are some ways to prevent marasmus:

Adopting a balanced diet

The best way to avoid marasmus is to adopt a balanced diet with a toddler diet containing protein from milk, fish, eggs or nuts.

In addition, consumption of vegetables and fruit is needed to meet the needs of vitamins and minerals in order to avoid malnutrition in general.

Keep the environment clean

Good sanitary conditions and environmental hygiene can reduce the risk of marasmus. Especially in places where there is no supply of clean water and healthy food.

Poor sanitation and hygiene can increase the risk of infection, which is a sign of marasmus and other types of malnutrition.

This can make the condition even more difficult to cure.

Prevention of infection

Prevention of infection is also important because various diseases can potentially cause nutritional problems in a person, especially if he has had marasmus.

This can be done by maintaining personal and environmental hygiene, and ensuring that the food consumed is free from disease.

In the infant age group, protection is also carried out by means of breastfeeding to meet nutritional needs and strengthen endurance.

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