15 months old baby is brought by mother for eating too little and too thin built

He was 3 kg at birth.breastfeeding is being continued . He had been given ragi as complimentary feeds but he ate 2 or 3 times but small qty. They were giving cows milk from 8 months after diluting it equal qty of water

Formula feeds with one scoop to 100m l was also tried

He never had infections .he was less active than peers

His wt is 5 kg

No edema

Length 72 cm

Mid arm 11cm

Liver span 6 cm

Skin  hyopigmentation

Bigots spots plus b/l


Initial assessment Assess for general danger signs or emergency signs and take a history concerning:

■ recent intake of food and fl uids

■ usual diet before the current illness


■ duration and frequency of diarrhoea and vomiting

■ type of diarrhoea (watery/ bloody)

■ loss of appetite

■ family circumstances

■ cough > 2 weeks

■ contact with TB

■ recent contact with measles

■ known or suspected HIV infection/exposure.


■ shock: lethargic or unconscious; with cold hands, slow capillary refi ll (> 3 s), or weak (low volume), rapid pulse and low blood pressure

■ signs of dehydration

■ severe palmar pallor

■ bilateral pitting oedema

■ eye signs of vitamin A defi ciency:–dry conjunctiva or cornea, Bitot spots–corneal ulceration–keratomalacia

Pitting oedema on dorsum of foot. When pressure is applied for a few seconds, a pit remains after the fi nger is removed. Children with vitamin A defi ciency are likely to be photophobic and will keep their eyes closed. It is important to examine the eyes very gently to prevent corneal rupture.

■ localizing signs of infection, including ear and throat infections, skin infection or pneumonia

■ signs of HIV infection

■ fever (temperature ≥ 37.5 °C or ≥ 99.5 °F) or hypothermia (rectal temperature < 35.5 °C or < 95.9 °F)

■ mouth ulcers

■ skin changes of kwashiorkor:–hypo- or hyperpigmentation–desquamation–ulceration (spreading over limbs, thighs, genitalia, groin and behind the ears)–exudative lesions (resembling severe burns) often with secondary infection (including Candida).

■ Conduct an appetite test:




About Dr. Jayaprakash

Asst. Prof. of Pediatrics, ICH. Institute of Child Health. Gov. Medical College Kottayam. Kerala, India.

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