Is your child's belly getting bigger and limbs getting thinner? Let's learn about this (Kwashiorkor)?

Today we are going to talk about a dangerous condition that our little ones can develop, but we may not be fully aware of it. Sometimes when we see a child with a big belly and limp limbs, we think something else must be wrong. But this could be a severe nutritional deficiency called (Kwashiorkor) . So, it is very important to be aware of this.

What is Kwashiorkor? Let's understand it simply.

Simply put, Kwashiorkor is a condition caused by severe protein deficiency . Protein is essential for the growth of our bodies, especially young children. So, Kwashiorkor occurs when the body does not receive the required amount of protein and some essential micronutrients.

What happens in this case is that when there is not enough protein, the body's tissues accumulate water and swell. We call it `(edema)` in medicine. This swelling is the main characteristic that distinguishes Kwashiorkor from other malnutrition conditions. You can see that the child's limbs are thin, but the hands, legs, face, and especially the stomach are swollen. Seeing that swollen stomach, sometimes an uninformed person might think that the child has eaten well and is full. But in reality, he is suffering from severe malnutrition .

Who is most affected by this condition (Kwashiorkor)?

Kwashiorkor is a condition that is rarely seen in developed countries, such as Europe and America. It is most commonly seen in developing countries. The risk is higher in countries where poverty, food shortages, poor sanitation, and the spread of infectious diseases are common.

Although Kwashiorkor can affect anyone of any age, it most commonly affects young children, especially those between the ages of 3 and 5. This is the age when most children are weaned from breast milk and introduced to other foods. Sometimes, the diet they are given may be high in carbohydrates (i.e. starchy foods such as rice, bread, and potatoes) but low in protein and other nutrients. This is when the problem becomes more common.

What is the difference between (Kwashiorkor) and (Marasmus)?

Now you may be wondering, is Kwashiorkor the only severe form of malnutrition? No, there is another one called Marasmus . Kwashiorkor and Marasmus are the two main types of severe protein-energy undernutrition that health workers around the world recognize.

The main difference between these two is:

• Kwashiorkor is basically a protein deficiency .
• Marasmus is a condition in which all macronutrients, such as protein, carbohydrates, and fat, are reduced, meaning the total calorie intake is reduced.

Simply put, a person with marasmus looks thin and emaciated. They are generally not getting enough calories. Either they are eating too little, or their body is using up too much energy (for example, from a persistent diarrhea), or both. But a person with kwashiorkor may not seem to be eating enough calories because of the swelling, but they are not getting enough protein.

What are the symptoms of Kwashiorkor? How do we recognize it?

Okay, so how do we recognize this condition (Kwashiorkor)? What are the symptoms that a child may see? It is very important to be aware of these, because then we can take action quickly.

• Swelling (edema): This is the main symptom. Especially in the ankles, legs, hands, and face, swelling appears as if water has filled them.
• Abdominal distention (large belly): The abdomen becomes enlarged due to fluid accumulation (ascites). Some people also call this a "tummy tuck".
• Hair changes: Hair becomes dry, brittle, hair falls out, sometimes hair color changes, becoming lighter (pigmentation decreases).
• Skin problems (Dermatitis): The skin becomes dry and flaky. In some places, it may appear as a crust or red spots. If it gets injured, it will not heal quickly.
• Enlarged liver: This may be a symptom of fatty liver disease.
• Muscle wasting: The muscles in the limbs become thin and thin. But surprisingly, the subcutaneous fat under the skin may remain the same.
• Dehydration: Lack of water in the body.
• Anorexia: Loss of appetite and desire to eat.
• Irritability and excessive fatigue: The child is often irritable, lethargic, and has no interest in playing.
• Children's growth is slow: they are not growing taller, they are not gaining weight, and they are smaller than other children their age.

Other complications that may occur due to Kwashiorkor

In addition to these symptoms, if the condition (Kwashiorkor) is not treated properly, it can lead to more serious complications. These can even be life-threatening.

• Low blood sugar levels (Hypoglycemia).
• Decrease in body temperature `(Hypothermia)`.
• Decreased blood volume (Hypovolemia) and the resulting shock (hypovolemic shock).
• Electrolyte imbalances in the body due to dehydration.
• The immune system is extremely weak. As a result, infections (such as fever, colds, diarrhea, lung infections) occur frequently, and wounds take a long time to heal.
• Cirrhosis of the liver (hardening of the liver) and liver failure.
• The pancreas (which produces the enzymes that help us digest food) shrinks, causing digestive problems.
• Thinning of the lining of the digestive tract (gastrointestinal mucosa). This can sometimes lead to small intestinal bacterial overgrowth.
• Severely delayed growth and brain development in children.
• Ultimately, fasting can even lead to death.

Why does this (Kwashiorkor) occur? What are the causes?

Protein deficiency is considered the main cause of Kwashiorkor. Many researchers believe that this is the main cause. However, some do not fully accept this. Because in some cases, adding protein to the diet has not been able to prevent or cure Kwashiorkor. This shows that protein deficiency is only part of the story, there may be other causes.

The main issues related to Kwashiorkor are:

• Eating a diet high in carbohydrates: Especially in poorer parts of Africa, Central America, and Southeast Asia, which are high-risk areas, people often have to eat only one type of carbohydrate. For example, starchy vegetables like rice, corn, cassava, and sweet potatoes. These are cheaper and easier to find than protein-rich foods (like fish, meat, eggs, milk, and lentils). This is especially true in rural areas where farming is practiced. Imagine, in some families, children may only be given rice and mashed potatoes all day. Then they do not get enough protein. Mothers who are protein-deficient can pass that deficiency on to their children.
• Inadequate replacement food after weaning: The name Kwashiorkor comes from the language of the African country of Ghana. It means something like "the disease that the older baby gets when the new baby arrives." This refers to a very common condition. When a new baby is started on breastfeeding, the older baby who is still breastfeeding is suddenly weaned. Then, either due to lack of resources, ignorance about nutrition, or both, the weaned baby does not get a proper replacement food. Then his nutritional status deteriorates. Some mothers give their young child only a little rice or porridge. But they forget to add something high in protein like lentils, a small piece of fish, or an egg yolk, or they do not have enough money to do so.

In addition to this, there are several other factors that can contribute to the development of Kwashiorkor:

• Deficiency of essential vitamins (like vitamin A, B vitamins) and minerals (like iron, zinc).
• Lack of antioxidants (these are substances that protect the body's cells) in the diet.
• Aflatoxins are toxins that come from a type of mold that grows on grains and peanuts grown in warm, humid climates.
• Parasites such as worms and infectious diseases such as measles, malaria, and HIV. These diseases weaken the body and reduce the absorption of nutrients.
• Major stressful situations in life, such as famine, poverty, war, and natural disasters.

How is Kwashiorkor diagnosed?

How do doctors accurately diagnose this condition (Kwashiorkor)?

Most of the time, a doctor will first diagnose the condition by physically examining the child and looking for the symptoms we discussed earlier (especially swelling, skin changes, and hair changes) .

In addition:

• Ask the mother or caregiver about the child's diet, what types of food they eat daily, and whether they are getting enough protein.
• Ask about previous illnesses and ongoing infections.
• The child's weight-to-height ratio and height-for-age are measured and compared with the World Health Organization's growth charts. These measurements can give the doctor a good idea of ​​how severe the child's malnutrition is and how much it has affected their growth.

How is Kwashiorkor treated?

Kwashiorkor is a condition that requires emergency medical treatment. The longer treatment is delayed, the more complications can occur. The World Health Organization (WHO) has outlined 10 steps to follow when treating severe malnutrition. These should be done very carefully, under medical supervision in a hospital.

1. Preventing/Treating Hypoglycemia: When malnourished children are given food suddenly, their blood sugar levels can drop dangerously low. Therefore, specially formulated fluids (containing glucose) are given gradually.

2. Preventing/Treating Hypothermia: Malnourished animals have difficulty regulating their body temperature. Therefore, they need to be kept warm (with warm clothes, blankets).

3. Prevention/Treatment of Dehydration: A special formula called RESOMAL (`REhydration SOlution for MALnutrition`) is given to treat dehydration in Kwashiorkor. It is designed to restore and maintain the balance of fluids and salts (especially sodium) in the body. It can be given by mouth or, if necessary, through a tube.

4. Correcting electrolyte imbalances: Electrolyte imbalances in the body, such as potassium and magnesium, are serious and can be life-threatening. These can change, especially when someone who is malnourished starts eating again. Health workers try to correct these first, often through the (RESOMAL) solution.

5. Prevention/Treatment of Infections: Due to the weakened immune system that comes with Kwashiorkor, any infection is a serious threat to recovery. Therefore, even if there is any doubt, broad-spectrum antibiotics are given.

6. Correcting micronutrient deficiencies: Essential vitamin and mineral deficiencies like vitamin A, folic acid, zinc, and iron are corrected. However, iron is only given after the child has recovered a little.

7. Start feeding carefully: This is a very important step. The metabolism (the body's way of producing and using energy) of malnourished people has changed. When they start feeding again, their metabolism starts to change again. But if this happens too quickly, a life-threatening complication called ``refeeding syndrome'' can occur. Therefore, feeding is started very carefully, in small amounts, several times a day, under close supervision. Especially in (Kwashiorkor), protein should be reintroduced gradually, little by little.

8. Catch-up growth: Once the child's condition has stabilized and appears to be tolerating feedings well, the amount of calories and protein given is gradually increased. The World Health Organization has developed specially formulated, nutritionally rich, ready-made therapeutic foods (RUTF). These can be given orally or by tube, if necessary. This is the nutritional rehabilitation phase. This can take several weeks (usually 2-6 weeks).

9. Provide sensory stimulation and emotional support: Children with Kwashiorkor may be lethargic and lethargic for a long time. Their intellectual, neurological, and social development may be stunted due to malnutrition. Stimulating activities such as toys, talking, and giving love and affection to help them regain their development are part of the treatment plan. If possible, health workers will also involve the child’s mother in this process.

10. Preparing for follow-up after recovery: Before the baby is discharged from the hospital, health workers provide education and counseling to the mother (or caregiver) about nutrition, breastfeeding, how to prepare a balanced diet, food and water hygiene, and disease prevention. If necessary, immunizations are given. If possible, help to obtain a stable, nutritious food supply.

How to prevent Kwashiorkor?

"It is better to prevent a disease than to treat it after it has developed." So there are things we can do to prevent (Kwashiorkor).

• Education and awareness: It is very important to educate parents and the community about basic nutrition, the importance of breastfeeding (exclusive breastfeeding for at least 6 months, followed by breastfeeding with complementary foods for up to 2 years), the nutritional needs of children and mothers. It is also necessary to teach how to start complementary foods at the right age and in the right way.
• Nutritional support: Implementation of nutritional programs by the government and various organizations. For example, providing nutritional supplements (e.g. Thriposha) to pregnant mothers, lactating mothers and young children. Also, promoting local crops (such as moringa, spinach, peas, soy) that provide protein and micronutrients.
• Disease control: Control of communicable diseases (such as diarrhea, respiratory infections) and infections. These weaken the body and reduce the absorption of nutrients. Improving hygiene (washing hands, drinking clean water, using toilets) and providing timely immunizations go a long way in preventing malnutrition.
• Food security: Every family should have access to nutritious food.

What happens if Kwashiorkor is left untreated? What are the prospects for recovery?

This is something we definitely need to know.

If left untreated, Kwashiorkor can be fatal. Death can occur from infection, dehydration, heart failure, or liver failure.

Even when treatment begins, there is a risk of the previously mentioned complication called ``refeeding syndrome.'' That is why treatment is done by hospitalization and under medical supervision.

However, children who are successfully and timely treated and rehabilitated can make a good recovery. Although there are some long-term effects of Kwashiorkor (e.g., stunted growth, learning disabilities), they can also go away.

Complications from kwashiorkor become more severe and last longer the longer it is left untreated. Some children may never fully recover from their growth and development delays. They may continue to be susceptible to liver disease and pancreatic insufficiency.

So, remember, the sooner the disease is diagnosed and treatment begins, the better the outcomes.

Finally, Kwashiorkor may not look like malnutrition because of the swelling and bloating. It can also have unexpected, hidden side effects like loss of appetite and fatty liver disease. To properly treat Kwashiorkor, it is important to understand it. Simply giving a high-protein diet at home may not be enough, and may even be dangerous. Therefore, if you have symptoms of Kwashiorkor, it is important to seek medical advice as soon as possible, especially in young children. The sooner you intervene, the less likely you are to suffer from malnutrition.

So, what are the most important things we should remember from this story?

Remember this well:

• Kwashiorkor is a severe malnutrition condition caused by protein deficiency , especially affecting young children.
• The main symptoms are a large belly, swollen limbs, but a thin body . In addition, there may be changes in the skin and hair, loss of appetite, and irritability.
• This is a potentially fatal condition, so immediate medical attention is essential. Do not attempt to treat it at home.
• Pay attention to your child's diet, especially protein-rich foods (such as fish, meat, eggs, milk, lentils, and peas). Make sure your child is getting proper nutrition when weaning from breast milk.
• Hygiene (hand washing, clean water) and disease prevention (vaccination) help reduce this situation.
• If your child has any of these symptoms, do not delay and visit the nearest doctor or hospital. Prompt treatment can save the child's life and reduce long-term effects.

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