Overview:
India is a country with 1.4 billion populations with heavy burden of chronic disorders related to children. Many paediatric patients struggles with chronic malnutrition, physical disability, cognitive impairment and their family have to face heavy financial burden because of longer hospitalisation. It impose healthcare providers to finds proper solution to overcome these scenario. Nutrition rehabilitation is one of the proven method that guarantees good outcome.
Introduction :
Nutrition is process of providing and obtaining food necessary for health growth and development of a child. Rehabilitation is a set of interventions that helps children with health conditions.
Nutrition contains two main elements, macro nutrients and micro nutrients. Macro nutrients are required for musculoskeletal growth where micro nutrients are necessary for various biochemical metabolism, cognition and immunity maintenance.
Protein is necessary for muscle and hair growth where carbohydrate is for energy . Lipid helps to built up energy storage house. Iron is a key component of HB which helps to delivers oxygen and generation of energy. It also helps in child’s cognition along with vitamin b12 and thiamine. Zinc helps in various metabolism, digestion and immunity maintenance. Vitamin D, Calcium, magnesium and phosphorus are necessary for bone health. Vitamin C help in collagen formation which maintains integrity of gums and skin. So whether it is physical or mental wellness, these micronutrients play important role in children’s life.
Effect of nutritional deficiencies:
Protein deficiency can lead to muscle weakness, hormonal imbalance and acute malnutrition in child where lipid and carbohydrate deficiency can lead to weight loss and marasmus. Iron and folic acid deficiency can lead to anaemia, zinc deficiency can lead to diarrhoea, low immunity and poor healing, vitamin B12 and thiamine deficiency can lead to poor cognition. Vitamin D3 and phosphorus deficiency can lead to rickets. Vitamin C deficiency can lead to scurvy.
Causes of nutritional deficiencies:
There are some conditions in which child can develop nutritional deficiency. Most common condition is toddler or adolescent stage when energy and nutrients requirements are high because child is in rapidly growing phase. Condition like celiac disease, cystic fibrosis, short bowel syndrome where absorption of nutrients are impaired and it can creates various nutritional deficiency. Some chronic illness like TB, cancers or metabolic disorders can lead to increase demand of nutrients and when supply doesn’t meet demand, nutritional deficiency take place. Some disorders like physical disability, muscular dystrophy, chronic ICU admission limits paediatric patients intake of food and can lead to nutritional deficiency.
Because of all these conditions, patients immunity and cognitive function impairs and it may lead to delayed recovery and longer hospitalisation and this vicious cycle continues. Eventually it may lead to permanent morbidity or mortality. So it is very important to intervene this cycle.
Intervention strategy:
To implement nutritional rehabilitation strategy, it requires multidisciplinary method. Nutritional deficiency can be corrected by scheduling proper diet plan according to patients need. If patient cannot tolerate oral diet then enteral or parental feeding should be initiated. After initiating nutritional rehabilitation patient will need physical support for early mobilisation. For that, role of physiotherapist is critical. It decreases hospitalisation duration and enhance early recovery. Some children may face anxiety or depression during rehabilitation process. So they should be provided psychiatric support.
Related Challenges:
Many challenges are also there to implement this strategy. It required team of specialist doctors, physiotherapist and dieticians. Their availibity at remote area is concern. The process is costly and time consuming, so affordability is big question for many families. Family and society support plays crucial role to facilitate recovery.
Policies and programs:
Government should set up rehabilitation centres at every district. There should be policies and programs to support the idea. Private organisation can also contribute thier financial support to poor families
Conclusion:
Nutritional rehabilitation is complex process which requires multidisciplinary action and involvement of Government and private organisation. It is essential to reduce hospitalisation days, rapid recovery and improves overall outcome of paediatric patients with chronic disorders .
References:
International Institute for Population Sciences. National Family Health Survey (NFHS-4) Mumbai: International Institute for Population Sciences; 2016.
Golden MH. Evolution of nutritional management of acute malnutrition. Indian Pediatr. 2010;47:667–78. Doi: 10.1007/s13312-010-0103-5. [DOI] [PubMed] [Google Scholar]
Waterlow JS. Reflections on stunting. In: Gopalan C, editor. Recent trends in nutrition. Delhi: Oxford University Press; 1993
