Durban - In the early months, the only food that a baby requires to meet his or her nutritional needs is milk – either breast or formula.
Breast milk provides antibodies to fight infections, as well as hormones and other growth-promoting factors.
The high level of fatty acids in breast milk also protects babies who are susceptible to allergies.
The composition of breast milk adjusts if the baby is premature and adapts as she grows and her needs change – it will even become more diluted in hot weather to satisfy her thirst.
Malnutrition in poverty-stricken areas occurs because of a lack of food. However, it occurs elsewhere due to premature weaning of babies before six months on to solids.
Malnutrition in babies and toddlers is life threatening, it hinders growth, lowers their potential, and may result in death or brain dysfunction.
Kwashiorkor is a condition characterised by severe protein and nutrient deficiency. It is generally found in young babies between 12 months and 2 years.
Top-up feeds in the form of formula reduce the breast milk quantity (the only protein the baby takes in).
It is also common to find mothers diluting infant-formula because of the cost involved. This results in inadequate intake of protein and energy needed for growth and development.
New mothers are furthermore encouraged by family, friends and even paediatricians to provide the baby with cereal or maize meal at six weeks, again resulting in inadequate breast milk supply, dependence on formula and the cycle repeats.
THE APPEARANCE OF A CHILD SUFFERING FROM KWASHIORKOR:
The child is small for her age and underweight.
* The baby looks swollen (puffy appearance of the hands, feet and eyes and abdomen) disguising the weight loss.
* The hair is thin, straight and lifeless, sometimes red or grey.
* There are dry patches of skin pigmentation in the neck and hairline, groin, face and buttocks.
* The babies and infants present with a decreased appetite, and vomiting and diarrhoea is common due to parasites and infections that may result in death.
* They are irritated and listless.
MARASMUS
Marasmus is found in a child in a state of chronic starvation because of a lack of food.
The onset of marasmus is found between 3 months and 1 year. It is generally associated with inadequate nutrition after a baby is weaned. The children will present with stunted growth, muscle wasting and a loss of subcutaneous fat and will have hypotonic muscles.
It is common for the child with marasmus to have kwashiorkor as well. Vitamin A deficiency is an indication of long-term malnutrition. Most children with vitamin A deficiency are also protein-energy malnourished.
IT IS IMPORTANT TO KNOW THAT:
Regardless of how babies are fed, newborns lose weight during the first three to four days after birth. Most babies regain their birth weight by 10 days to two weeks after birth;
* Babies who are sick or premature take longer to regain their birth weight than healthy, full-term babies.
* Average weight gain for the first three to four months is about 150 to 200g a week.
* Growth in length averages 2.5cm a month.
* Growth in head circumference averages 1.27cm a month during the first six months.
* Length and head circumference (indicating brain growth) should develop at the same rate for bottle-fed babies and breast-fed babies.
* Babies grow rapidly during the first three months, after which it typically slows down during months four to twelve.
* The average breast-fed baby doubles his birth weight by four to six months.
* Generally, breast-fed babies put on more weight initially than bottle-fed babies, but then become leaner and lighter at around three months
TREATING KWASHIORKOR AND MARASMUS
The treatment of these conditions includes the provision of adequate (quality and quantity) foods that contain protein, energy, fats and carbohydrates. The child responds mostly to high-protein intake very well, without life-long consequences.
Growth charts are useful tools to monitor a baby’s growth by plotting the weight on a graph-like chart. It can be a good indication that the baby is feeding and developing well. The baby’s height, weight, and head size should be checked with every visit to the clinic. The only cause for concern is any excessive weight gain or weight loss.
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Dr Diana du Plessis is an independent midwifery consultant and researcher.
diana.duplessis@mweb.co.za
The Mercury