🥣 Assignment on Protein Energy Malnutrition

Subject: Nursing Assignment | Suitable For: ANM / GNM / BSc Nursing Students

📄 1. Cover Page

📄 2. Introduction

Protein Energy Malnutrition, commonly known as PEM, is a serious nutritional disorder caused by inadequate intake of protein and calories. It is most commonly seen in infants and young children, especially between 6 months to 5 years of age. PEM affects growth, immunity, physical activity, mental development and overall health of the child.

PEM is a major public health problem in developing countries. It commonly occurs due to poverty, lack of nutrition knowledge, improper breastfeeding, delayed complementary feeding, recurrent infections, poor sanitation and food insecurity. The two severe clinical forms of PEM are marasmus and kwashiorkor.

📄 3. Definition

Protein Energy Malnutrition is a nutritional disorder caused by deficiency of protein and energy in the diet, resulting in growth failure, weight loss, wasting, weakness and increased susceptibility to infections.

📄 4. Causes of Protein Energy Malnutrition

• Inadequate intake of protein and calories.
• Poverty and food insecurity.
• Improper breastfeeding practices.
• Delayed or inadequate complementary feeding.
• Repeated infections such as diarrhea, pneumonia and measles.
• Worm infestation.
• Low birth weight.
• Large family size.
• Lack of knowledge regarding child nutrition.
• Poor hygiene and unsafe drinking water.
• Early discontinuation of breastfeeding.
• Food taboos and faulty feeding practices.

📄 5. Risk Factors

• Children below 5 years of age.
• Low birth weight babies.
• Children not exclusively breastfed.
• Children with recurrent diarrhea.
• Children with chronic illness.
• Children from low socio-economic families.
• Delayed weaning or poor complementary feeding.
• Poor maternal education.
• Poor sanitation and overcrowding.

📄 6. Types of Protein Energy Malnutrition

• Marasmus: Severe deficiency of both calories and protein.
• Kwashiorkor: Severe protein deficiency with relatively adequate calories.
• Marasmic Kwashiorkor: Features of both marasmus and kwashiorkor.

📄 7. Marasmus

Marasmus is a severe form of PEM caused by deficiency of both calories and protein. It is commonly seen in infants below one year of age. The child appears extremely thin due to severe wasting of muscles and subcutaneous fat.

Clinical Features of Marasmus

• Severe wasting of muscles and fat.
• Very low body weight.
• Old man appearance.
• Thin and wrinkled skin.
• Prominent ribs and bones.
• No edema.
• Child is usually alert but irritable.
• Appetite may be present.
• Growth failure.
• Frequent infections.

📄 8. Kwashiorkor

Kwashiorkor is a severe form of PEM mainly caused by protein deficiency. It is commonly seen after weaning when the child is given carbohydrate-rich but protein-poor diet. Edema is the most important feature of kwashiorkor.

Clinical Features of Kwashiorkor

• Bilateral pitting edema.
• Puffy face or moon face.
• Swollen abdomen.
• Skin changes such as flaky paint dermatosis.
• Hair becomes thin, sparse and discolored.
• Poor appetite.
• Irritability and apathy.
• Growth failure.
• Fatty liver may occur.
• Frequent infections.

📄 9. Difference Between Marasmus and Kwashiorkor

📄 10. Signs and Symptoms of PEM

• Low body weight.
• Failure to gain weight.
• Growth retardation.
• Muscle wasting.
• Loss of subcutaneous fat.
• Weakness and lethargy.
• Irritability.
• Poor appetite.
• Dry skin and hair changes.
• Pallor due to anemia.
• Frequent diarrhea and respiratory infections.
• Delayed milestones.
• Edema in kwashiorkor.
• Reduced immunity.

📄 11. Diagnostic Evaluation

• Measurement of weight and height.
• Mid Upper Arm Circumference measurement.
• Growth chart monitoring.
• Weight-for-age, height-for-age and weight-for-height assessment.
• Clinical examination for wasting, edema, hair and skin changes.
• Dietary history and feeding history.
• Hemoglobin estimation.
• Serum protein and albumin level.
• Blood sugar level in severe malnutrition.
• Stool examination for worm infestation.
• Assessment for associated infections.

📄 12. Management of PEM

• Correct hypoglycemia and hypothermia in severe cases.
• Treat dehydration carefully.
• Treat infections with appropriate medicines.
• Correct electrolyte imbalance.
• Provide micronutrient supplementation.
• Start feeding gradually with small frequent feeds.
• Provide high-calorie and high-protein diet.
• Continue breastfeeding if child is breastfed.
• Give vitamin A, folic acid and other supplements as advised.
• Treat anemia after stabilization.
• Provide sensory stimulation and emotional support.
• Refer severe acute malnutrition cases to Nutrition Rehabilitation Centre.

📄 13. Nursing Management

• Assess nutritional status of the child.
• Record weight, height and MUAC regularly.
• Monitor vital signs, temperature and hydration status.
• Maintain warmth and prevent hypothermia.
• Provide small frequent feeds as advised.
• Maintain strict hygiene to prevent infection.
• Administer medicines and supplements as prescribed.
• Observe for vomiting, diarrhea, edema and signs of infection.
• Educate mother regarding feeding practices.
• Encourage breastfeeding and proper complementary feeding.
• Provide emotional support to child and mother.
• Maintain intake-output chart if required.
• Refer severe cases to higher health facility.

📄 14. Nursing Care Plan

📄 15. Diet Plan for PEM

Children with PEM require energy-rich and protein-rich foods. Feeding should be started gradually in severe cases and increased according to tolerance. Locally available foods should be used so that the family can continue the diet at home.

📄 16. Prevention of PEM

• Promote exclusive breastfeeding for first 6 months.
• Start complementary feeding after 6 months.
• Continue breastfeeding up to 2 years or beyond.
• Provide balanced diet according to age.
• Give small frequent meals to young children.
• Maintain personal hygiene and food hygiene.
• Use safe drinking water.
• Prevent and treat diarrhea early.
• Ensure complete immunization.
• Monitor growth regularly at Anganwadi or health centre.
• Provide vitamin A and iron supplementation as advised.
• Educate parents regarding child nutrition.

📄 17. Health Education

• Explain importance of protein and calorie-rich diet.
• Teach mother about exclusive breastfeeding for 6 months.
• Explain complementary feeding after 6 months.
• Advise giving thick and nutritious food instead of watery food.
• Encourage locally available foods like dal, rice, khichdi, milk, egg and vegetables.
• Teach hand washing before cooking and feeding.
• Advise safe drinking water and proper sanitation.
• Encourage complete immunization.
• Advise regular growth monitoring.
• Teach danger signs like poor feeding, edema, severe weakness, fever and diarrhea.
• Advise early treatment of infections.

📄 18. Complications of PEM

• Severe infection.
• Hypoglycemia.
• Hypothermia.
• Dehydration.
• Anemia.
• Electrolyte imbalance.
• Growth failure.
• Delayed development.
• Reduced immunity.
• Increased risk of death in severe cases.

📄 19. Role of Nurse

• Identify children at risk of PEM.
• Measure weight, height and MUAC.
• Monitor growth using growth chart.
• Assess feeding practices and dietary intake.
• Provide nutrition education to mother and family.
• Promote breastfeeding and complementary feeding.
• Detect danger signs and refer severe cases.
• Coordinate with Anganwadi worker and community health worker.
• Maintain records and follow-up.
• Conduct health education sessions in community.

📄 20. Conclusion

Protein Energy Malnutrition is a serious but preventable nutritional disorder commonly affecting infants and young children. It occurs due to inadequate intake of protein and calories, poor feeding practices, infections and poverty. Early identification, proper feeding, infection control, growth monitoring, immunization, health education and timely referral are essential for prevention and management of PEM. Nurses play an important role in assessment, counselling, treatment support and follow-up care.

📄 21. Bibliography

1. K. Park, Textbook of Preventive and Social Medicine.
2. Ghai Essential Pediatrics.
3. Basavanthappa, Community Health Nursing.
4. Indian Nursing Council Practical Guidelines.
5. Government of India Child Health and Nutrition Guidelines.