02/01/2023 1

Common Health Problems

in Pakistani Children and
their Nursing Managements
Assigned by: Mam Rida

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Assigned to
• Maria Javed • Warisha Naz
• Hina Murtaza • Muqaddas Fatima
• Kinza Amjad • Musharib Jameel
• Rimsha Firdous • Seemav Tariq
• Zoha Khan • Samvaia Nawaz
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Common Health
Problems in Pakistani
Children

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Objectives

• Discuss nutrition disturbance

• Describe protein energy malnutrition
• Elaborate feeding to thrive
• Discuss sudden infant death syndrome
• Explain teething problems
• Describe nursing managements or care 02/01/2023 5
 Nutrition disturbance
oIn Pakistan, four out of ten children under
five years of age are stunted while 17.7%
suffer from wasting. The double burden of
malnutrition is becoming increasingly apparent,
with almost one in three children underweight
(28.9%) alongside a high prevalence of
overweight (9.5%) in the same age group.

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 Conti.
oThe most common nutrient deficiencies among school children
are: calcium, fiber, folate, iron, magnesium, potassium and vitamin
E. It has been reported that the 2 most common deficiencies seen
in generally healthy children are iron and vitamin D deficiencies.
oInadequate nutrition among mothers during pregnancy is one of
the main reasons of malnutrition among children leading to
stunting.

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Conti.
oThe major nutritional problems are low birth weight due to poor
maternal nutrition, protein energy malnutrition, anemia,
iodine deficiency disorders and other micronutrient deficient.

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Causes

Malnutrition is not only about lack of food; a combination of

other causes lead to malnutrition in children , including;
 Diet at home
 Illnesses such as malaria and water-borne diseases
 limited access to clean water and sanitation infrastructure
 knowledge about safe hygiene practices, lack of access to health
  Maternal undernutrition 02/01/2023 9
Symptoms

• Dry skin or hair • Depression or anxiety making

• Low energy their way
• Bone pain • Poor appetite
• Brittle and Dry Hair • Restlessness
• Diarrhea • Obesity
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Treatment

Children need to consume sufficient calories and key nutrients

that aid in childhood growth and development including:
Vitamin D: Contributes to the development of strong bones
Calcium: Maintains skeletal growth and mineral balance of
strong bones
Protein: Helps support muscle development
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02/01/2023 12
Protein Energy Malnutrition
• Protein-energy undernutrition (PEU), previously called protein-
energy malnutrition, is an energy deficit due to deficiency of all
macronutrients. It commonly includes deficiencies of many
micronutrients.
• Macronutrients required in large amount like, carbohydrates ,
proteins and fats.
• Micronutrients required in small amount like , vitamins and minerals
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Sign and symptoms
 

•Poor weight gain

•Slowing of linear growth 
•Behavioral changes - Irritability
•decreased social responsiveness
•Anxiety
•Attention deficits
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Causes
• Kwashiorkor (malnutrition with oedema) occurs when calorie intake is
adequate but protein intake is deficient, while the more common
marasmus (severe wasting disease) is due to a deficiency of both protein
and total calories.

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Treatment
 Milk-based formulas are the treatment of choice. At the
beginning of dietary treatment, patients should be fed ad libitum.
After 1 week, intake rates should approach 175 kcal/kg and 4 g/kg
of protein for children and 60 kcal/kg and 2 g/kg of protein for
adults. A daily multivitamin should also be added.

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 Feeding Difficulties
• The term feeding difficulties is a broad term used to describe a
variety of feeding or mealtime behaviour perceived as problematic
for a child or family.

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Causes
• Poor feeding
• A lack of interest in feeding
• A problem receiving the proper amount of nutrition
• It is a nonspecific symptom seen in newborn and young infants
that can result from many conditions, including
• Infection,
metabolic disorders, genetic disorders, structural
abnormalities, and neurological disorders
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 Symptoms
• Regularly takes a long time to eat (more than 30 minutes) 
• Falls asleep or isn't alert when feeding
• Avoids foods with certain textures
• Drools a lot
• coughs or gags when feeding

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Treatment

 Referral to a doctor for medical treatment, like medicines for reflux

 Feeding therapy.
 Trying different foods or adding calories to their diet.
 Trying new ways to get your child to try new foods or textures.
 Changing how hot or cold food is or how crunchy or soft it is.
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 Cont.
 Feeding therapy, in its simplest form, is when a trained occupational
or speech therapist helps teach a child how to eat or eat better.
 Feeding therapy typically occurs once or twice a week for 1 hour
each time, and at NAPA within its intensive model of 1 hour per
day, 5 days per week, for 3 weeks.

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Failure to thrive
•  Children are diagnosed with failure to thrive when their weight or
rate of weight gain is significantly below that of other children of
similar age and sex.
• Infants or children that fail to thrive seem to be dramatically
smaller or shorter than other children the same age.

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Causes
oThe most common cause of failure to thrive is not taking in
enough calories
oPoor feeding
oBabies and children need different amounts of calories based on
their age, size, sex, activity level, and medical needs
oHigh calorie demands
oSome medical conditions require a child to consume more calories
habits 02/01/2023 24
Symptoms

• Delayed motor development

• Fatigue
• Lake of weight gain
• Delays in reaching developmental milestones, such as rolling over,
crawling, and talking
• Learning disabilities
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Treatment
• The treatment depends on the cause of the delayed growth and
development.
• Delayed growth due to nutritional factors can be resolved
by educating the parents to provide a well-balanced diet.
• If psychosocial factors are involved, treatment should include
improving the family dynamics and living conditions.

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Sudden infant death syndrome

Sudden infant death syndrome (SIDS) is the sudden and

unexplained death of a baby younger than 1 year old.
A diagnosis of SIDS is made if the baby's death remains
unexplained even after a death scene investigation

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Causes
• Sex. Boys are slightly more likely to die of SIDS
• Age. Infants are most vulnerable between the second and fourth
months of life
• Race. For reasons that aren't well-understood, nonwhite infants are
more likely to develop SIDS
• Family history
• Secondhand smoke
• Being premature 02/01/2023 29
Symptoms

• SIDS has no symptoms or warning signs.

• Babies who die of SIDS seem healthy before being put to bed.
They show no signs of struggle and are often found in the same
position as when they were placed in the bed

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 Treatment

• There's no treatment for sudden infant death syndrome, or SIDS .

But there are ways to help your baby sleep safely.
• For the first year, always place your baby on his or her back to
sleep.
• Use a firm mattress and avoid fluffy pads and blankets

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Teething problems
• During the teething period there are symptoms that include irritability,
disrupted sleep, swelling or inflammation of the gums, drooling, loss
of appetite, rash around the mouth, mild temperature, diarrhea,
increased biting and gum-rubbing and even ear-rubbing

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Symptoms
• Swollen, tender gums
• Fussiness and crying
• A slightly raised temperature (less than 101 F)
• Gnawing or wanting to chew on hard things
• Lots of drool, which can cause a rash on their face
• Coughing.
• Rubbing their cheek or pulling their ear
• Bringing their hands to their mouth 02/01/2023 33
Treatment

oIf your child's gums are swollen and tender, gently rub or

massage the gums with your finger, or give your child a
teething ring made of firm rubber to chew. Make sure the
teething ring is not frozen. If the object is too hard, it can hurt your
child's gums
oTry an over-the-counter remedy

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Nursing management

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 Nursing management

• Nutritioninterventions may include optimizing the patient's oral

intake, providing oral nutrition supplements, and administering
enteral and parenteral nutrition.

• An overall goal related to nutritional imbalances is, “The patient

will weigh within normal range for their height and age.”
Outcome criteria are specific, measurable, achievable, realistic,
and time-oriented.
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Cont.

• Nurses have a responsibility to address patient nutritional needs

by conducting screenings, performing assessments and
administering interventions.
• But, malnutrition is not just a problem for patients. In the United
States, for example, people residing in areas far from grocery
stores have limited food choices.

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Cont.
• Eat smaller meals and snacks more frequently. ...
• Talk to your provider. ...
• Avoid non-nutritious beverages such as black coffee and tea;
instead choose milk and juices.
• Try to eat more protein and fat, and less simple sugars.
• Walk or participate in light activity to stimulate your appetite
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Post polio syndrome
Post-polio syndrome (PPS) is a condition that can affect polio
survivors decades after they recover from their initial poliovirus
infection. Unlike poliovirus, PPS is not contagious

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Symptoms

• Persistent fatigue (extreme tiredness)

• Muscle weakness
• Shrinking muscles
• Muscle and joint pain
• Sleep apnea

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Causes

• The exact cause of post-polio syndrome is unclear. It's not

known whether anything can be done to prevent it. The leading
theory is that it's the result of the gradual deterioration of nerve
cells in the spinal cord (motor neurones) that were damaged by the
polio virus.

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Treatment
• There's currently no cure for post-polio syndrome (PPS),
so treatment focuses on helping you manage your symptoms and
improving your quality of life. People with the condition are often
treated by a team of different healthcare professionals working
together.
• This is known as a multidisciplinary team.

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Chronic inflammatory demyelinating
polyneuropathy
• Chronic inflammatory demyelinating polyneuropathy (CIDP)
is characterized by hyporeflexia or areflexia and progressive or
relapsing motor and/or sensory dysfunction of more than one
extremity, developing over at least 2 months.

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Causes

o CIDP occurs when the body's immune system attacks the myelin

sheaths around nerve cells, but exactly what triggers this is not
clear.
oUnlike Guillain-Barre syndrome, there is usually no infection
preceding CIDP. There does not seem to be a genetic link to CIDP

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Symptoms
• Butler described CIDP as a disorder of the peripheral nerves that's
caused by damage to myelin, the protective covering around a
nerve.
• It often starts with some tingling or numbness in the toes and
fingers, progressing to weakness and impaired function in the legs
and arms.

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 Treatment
• Treatment for CIDP includes corticosteroids such as prednisone,
which may be prescribed alone or in combination with
immunosuppressant drugs. Plasmapheresis (plasma exchange) and
intravenous immunoglobulin (IVIg) therapy are effective

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References
• Centre for Community Child Health. Eating behaviour problems -
Practice Resource Accessed 8th March 2014
• De Onis M, Wijnhoven TMA, Onyango AW. Worldwide practices
in child growth monitoring. J Paediatric . 2018;144:461–
5. [PubMed]
• Handbook of Nutrition and Food, Third Edition by Carolyn D.
Berdanier (Editor); Johanna T. Dwyer (Editor); David Heber (Editor
Reference 2nd Fl QP141 .H345 2014
• Wolbert J, Higginbotham K. Poliomyelitis
(polio) Neurology. 2020 https://scholarlycommons.hcahealthcare.co
02/01/2023 47

mnneurology/26 Published online june 22

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