Most of the severely malnourished children who arrive in the facility have diarrhoea which sometimes persists even though they are being fed. What are the causes and how can we overcome this problem?
There are 4 main causes:- • Giving large feeds, or the wrong type of feed: Malnutrition damages the gut mucosa, reduces enzyme production, and flattens the villi, so the gut has less capacity to digest and absorb and is easily overloaded, causing diarrhoea • Micronutrient deficiencies: Adequate amounts of nutrients are needed to repair the damaged gut. If deficiencies are not corrected, diarrhoea may persist. Zinc, folic acid, and Vitamin A are especially important in restoring gut function • Small bowel overgrowth: Bacteria may colonise the upper gut in severe malnutrition and impair absorption, and this can lead to persistent diarrhoea. Potassium deficiency contributes to bacterial colonisation by slowing gut motility • Re-infection: Diarrhoeal pathogens spread easily and malnourished children have poor immunity so easily catch new infections. Actions:- • Feed small amounts: feed frequently. Use a feed chart to calculate the correct amount • Give F75 initially: it has low lactose • C
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