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
HISTORY
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
breastfeeding
■ 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.
EXAMINATION
■ 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:
Superintendent, ICH.