Undernutrition is a condition in which there is inadequate consumption, poor absorption or excessive loss of nutrients.
Extreme malnutrition and emaciation (especially in children); can result from inadequate intake of food or from malabsorption or metabolic disorders. Malnourished children may suffer from numerous associated complications.
They are more susceptible to infections, especially sepsis, pneumonia and gastroenteritis. Vitamin deficiencies and deficiencies of minerals and trace elements can also be seen.
Epidemiology of Marasmus –
Childhood undernutrition is an underlying cause in an estimated 35% of all deaths among children under five and 21 % of total global disability adjusted life years (DALYs) lost among under 5 children. According to the National Family Health Survey (NFHS) 3, carried out in 2005-06, 40% of India’s children under the age of three are underweight, 45% are stunted and 23% are wasted.
Overall, both girls and boys have similar prevalence of undernutrition. Prevalence of undernutrition is higher in rural areas (46%) than in urban populations (33%).
Symptoms of Marasmus
It results from rapid deterioration in nutritional status. Acute starvation or acute illness over a borderline nutritional status could precipitate this form of undernutrition. It is characterized by marked wasting of fat and muscle as these tissues are consumed to make energy. The main sign is severe wasting. The child appears very thin (skin and bones) and has no fat. There is severe
wasting of the shoulders, arms, buttocks and thighs
The loss of buccal pad of fat creates the aged or wrinkled appearance that has been referred to as
monkey facies. Baggy pants appearance refers to loose skin of the buttocks hanging down.
Axillary pad of fat may also be diminished. Affected children may appear to be alert in spite of
their condition. There is no edema
Symptoms of Kwashiorkor
It usually affects children aged 1–4 yr. The main sign is pitting edema, usually starting in the legs and feet and spreading, in more advanced cases, to the hands and face. Because of edema, children with kwashiorkor may look healthy so that their parents view them as well fed.
General appearance. Child may have a fat sugar baby appearance.
Edema. It ranges from mild to gross and may represent up to 5-20% of the body weight.
Muscle wasting. It is always present. The child is often weak, hypotonic and unable to stand or walk.
IAP Classification of malnutrition
This classification proposed by the Indian Academy of Pediatrics is based on weight for age values
standard used in this classification for reference population was the 50th centile of the old Harvard standards.
Grade of malnutrition Weight-for-age of the standard (%)
Grade I 71-80 (mild malnutrition)
Grade II 61-70 (moderate malnutrition)
Grade lll 51-60 (severe malnutrition)
Grade IV <50 (very severe malnutrition)
Homeopathic Medicines & Treatment for Marasmus, protein-energy malnutrition & Kwashiorkor
Homeopathy is one of the most popular holistic systems of medicine. The selection of homeopathic medicine for undernutrition is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathic medicine for undernutritionis not only to treat undernutrition but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available for undernutrition which can be selected on the basis of cause, location, sensation, modalities and extension of the complaints. For individualized homeopathic medicine for undernutrition and treatment, the patient should consult a qualified homeopathic doctor in person. Some important remedies are given below which are much helpful in treatment of undernutrition symptoms:Homeopathy offers good prognosis to cases of undernutrition.
This is our chief remedy, and corresponds to thin, emaciated children who are predisposed to glandular and osseous disease, who have large heads and defective bony development, as shown in the open fontanelles and tardy development of the teeth the spine is so weak that it cannot support the body, and it becomes curved, the neck is very thin, the complexion is sallow, the child is emaciated and poorly developed, vomits persistently and has a diarrhoea of green, slimy and undigested stools, accompanied with much offensive flatus. Calcarea iodata may also prove useful where there are engorged glands, enlarged tonsils and decided scrofulous tendencies.
The Calcarea are all valuable in marasmus. The carbonate has the defective nutrition and suits cases where the acidity predominates; there are sour stools and vomiting of milk, there is sweat on scalp, head and face, the feet are damp and cold, enlargement of the glands and voracious appetite. The body dwindles, yet the abdomen remains prominent. The appetite may be morbid, craving indigestible articles. The mesenteric glands are engorged and the fat of the body wastes. It is very valuable in those of scrofulous tendencies. Arsenicum has undigested stools and a diarrhoea on beginning to eat or drink; rapid emaciation with a harsh and dry skin. The debility, weariness and irritable restlessness will indicate the remedy. Phosphorus is also a nutrition remedy, and is indicated by the chest oppression, feeble heart, dyspnoea and tendency to diarrhoea, which is copious and exhausting. It suits delicate, refined children. The nervous centers seem to suffer most; exhausting sweats and great nervous debility mark the remedy.
A grand remedy in marasmus. It has the symptoms of extreme hunger, yet, in spite of this, the patient emaciates rapidly. It seems to suit acute cases with more or less febrile action. The action of the glands is interfered with, and there is great sluggish and torpor of the system; the face is yellow and shrunken.
This remedy suits marasmus from defective nourishment ; the neck is thin as under Calcarea carbonica, and the appetite is ravenous, though the patient grows thin. There is much thirst and water is craved all the time, as if the patient were possessed of an inward fever. the mouth and throat are dry and there is constipation. The emaciation is all out of proportion to the fever or diarrhoea; the skin is scurfy and may develop oozing eruptions. Craving for salt may also be present, and it is a useful indication.
Like its relative, Calcarea, this remedy is valuable in marasmus. It suits particularly puny children in whom milk is not borne well, causing pain when taken into this stomach, and is vomited undigested ; there are griping, colicky pains; the stools are sour and are green as grass. The child has the appearance of being improperly nourished; its mouth is full of ulcers, the glands are swollen and the abdomen is bloated. Mercurius is a valuable oftentimes and is indicated by such symptoms as emaciation, swollen and suppurating glands, a jaundiced appearance and a green, sour or watery stool accompanied by straining; the sweat is offensive and the gums are unhealthy.
Suits old looking children who have much heat about the head and cold feet, a hard , distended abdomen and a dirty, sallow , shrivelled skin; it hangs in folds ; the fingers are emaciated, almost resembling knitting needles. The stools are acrid , making the anus sore , and the child has an offensive faecal odor about it. There is excessive hunger at 11 A.M., and the skin is apt to be covered with various eruptions, eczema predominating. Particularly are the cervical, axillary and inguinal glands swollen and the voracious appetite is present. Dentition is slow and the muscles are tardily developed. Psorinum resembles Sulphur somewhat; it has the symptom that the patient has a foetid, there is great debility, dirty looking eruptions and boils. It will sometimes rouse the system when Sulphur fails.
This remedy stands between Sulphur and Calcarea carbonica. There is weakness of digestion, diarrhoea worse during the daytime, stools are greenish, slimy, undigested and sour, the whole body emitting a sour odor. The child apparently looks plump, but the flesh is flabby and the muscles withered. There is a tendency to unhealthy skin and suppurative conditions. Tendency to catarrhs from least draught of cold air.
Corresponds to dwarfish sluggish children who are weak in memory, whose cervical glands are swollen , who are lazy, pot-bellied, and who suffer from great physical and mental debility. The child wants to eat all the time, does not like sweet things or fruit and a little food satisfies. Artemisia abrotanum is also a remedy for marasmus. It has enormous appetite, child constantly cries for food,pain in the stomach and abdomen,bloating and large frequent stools; food passes undigested . Skin flabby, hangs loosely.