Figure 1. Marasmus in a child whose family had been displaced as a result of civil conflict in Angola. From: American Academy of Pediatrics. Atlas of Pediatrics in the Tropics and Resource-Limited Settings. Spector JM, Gibson TE, eds. Elk Grove Village, IL: American Academy of Pediatrics; 2009.While we feast with friends and families this holiday season, malnutrition contributes to millions of deaths each year. Fortunately, during this holiday season many people rise to new heights of generosity. We express compassion by helping people deemed “less fortunate.” Many of us are planning humanitarian service trips. This is good!
Simple mindedly, we want to help; we want to feed the hungry. However, even such “simple” interventions can be dangerous.
As Dr. Christian Pulcini and colleagues remind us in the “Refeeding Syndrome” article in December Pediatrics in Review, malnutrition is more than a lack of food. Severely malnourished patients have altered metabolism. Giving too much food too rapidly can kill malnourished children. Thus, as we deal with malnourished children, it is timely to be reminded about refeeding syndrome and how recovery should be planned and monitored carefully
Figure 2. Kwashiorkor showing peeling skin. From: American Academy of Pediatrics. Atlas of Pediatrics in the Tropics and Resource-Limited Settings. Spector JM, Gibson TE, eds. Elk Grove Village, IL: American Academy of Pediatrics; 2009.
For those of us who see malnourished children in resource-limited areas where even testing of serum electrolyte levels is not feasible, we can still refeed children safely by following the “Ten Steps” suggested by the World Health Organization. First, metabolic derangements must be corrected. As we attend to hypoglycemia, hypothermia, dehydration, electrolyte imbalances, infections, and micronutrient deficiencies, then we can begin cautious refeeding. The World Health Organization's 2013 Pocketbook of Hospital Care for Children provides easy-to-follow stepwise guidance about how to successfully restore body balances and refeed malnourished children, even with minimal laboratory support.
Traveling to areas where there are lots of malnourished children? You can download the WHO manual for free at here. Or, you can get the document at here. Another resource for professionals interested in global health is the AAP Textbook of Global Child Health. Whether at home or far away, let’s provide scientifically accurate and readily feasible care to hungry children.
Whether traveling or not, trainees wanting to supplement their routine pediatric education with global health perspectives can use the learning objectives and resources at The Global Health Pediatric Education Group (PEG) of the Association of Pediatric Program Directors to grow in an ability to adapt good pediatric knowledge to parts of the world with different sorts of people, epidemiology, and resources.
One more thing: Don’t miss the Refeeding Syndrome Teaching Slides that accompany this article. They provide a quick, on-the-spot reference to refeeding basics, good for study or, even better, on-site use.
