Index case: Child < 5 years

History
- Name - Age/Sex
- Address - Nearest health facility
- Presenting complaints - History of present illness
- Past history of illness - Family history of illness
- Family record /Social history:
a. Type of family b. Family size
c. Religion and ethnicity d. Education of father
e. Education of mother f. family tree
g. Income
Birth history
Type of delivery, place of delivery(home/health facility), presence of
trained birth attendants.
Any complications during delivery.
cried immediately after birth or not?
Term/preterm, Birth weight
Breastfeeding initiation, Colostrum feeding.
 adequate breast feeding
Infancy
Immunization
Developmental milestones- with respect to
movement and posture, reflexes, vision and
manipulation, hearing and speech, social
behavior.
Past history
Nutritional history of mother and child
Habits: Vegetarian/non-vegetarian mother, child- breast fed, EBF
for 6 whole months, weaning practices.
Assessment of dietary intake (mother and child):
 retrospective inquiries about the nature and quantity of foods
including breast milk, consumed, during the previous 24 or 48
hours.
 calculation of intake (grams)of food in terms of cereals, pulses,
vegetables, fruits, milk, meat, eggs etc.
Examination
1. Description: General appearance/built
2. Personal cleanliness: Nails/ dress/hair/skin etc
3. Body measurements (physical growth)
a. Weight
Classification of PEM according to IAP
o Normal - Wt. > 80% of expected for age
o Grade I - Wt. 71-80% of expected for age
o Grade II - Wt. 61-70% of expected for age
o Grade III – Wt. 51-60% of expected for age
o Grade IV – Wt. Less than or equal to 50% of
expected for age
(alphabet K is post-fixed in presence of edema.)
b. Length/height:
Length is measured in lying down position preferably on special measuring
board in children <2yrs of age.
Height is measured for children>2yrs of age preferably using stadiometer.
c. Arm circumference:
estimates the body’s muscle mass for children aged 6 –60months measured
by a MUAC tape(Shakir’s tape).
> 13.5cm (satisfactory nutritional status)
12.5 to 13.5cm (mild-moderate malnutrition)
< 12.5cm ( severe malnutrition)
d. Head circumference
measured for children under 2years (occipito-frontal)
birth(35cm),3month(40cm), 1yr(45cm), 2 yrs (48cms).
hydrocephalus suspected when the rate of growth of the head is
greater than normal for the age, sex and size of the infant.
4. Body temperature
5. Hair- normal/lack of luster/depigmentation/
thin or sparse.
6. Face - Diffuse pigmentation/moon face
7. Eyes - conjunctiva (normal, dry, pale, icterus)
- cornea (hazy or opaque)
- cataract
8. Lips - normal, angular stomatitis, cleft
lips/palate.
9. Tongue- normal, pale, fissured
10. Gums- normal, bleeding
11. Teeth
- eruption of teeth in the upper jaw and lower
jaw.
- caries and other dental abnormalities.
12. Glands
- thyroid enlargement/parotid enlargement
13. Ears
- hearing, discharge, accessory auricle
14. Respiratory system
- Respiratory rate
- chest indrawing/stridor/wheezing
- Any added breath sounds
15. Cardiovascular system
- location of the apex beat
- cardiac murmur
- arterial pulsation
16. G.I. System
- distension, abnormal masses, enlarged liver/spleen
17. External genitalia
- any abnormalities
- male: hypospadiasis, undescended testes,
hydrocele
- female: fused labia, enlarged clitoris
18. Limbs and joints
Oedema, bow legs, other deformities
19. Neuro-behavioural activities
- neck retraction - movements
- Tendon reflexes -cry
- hyperextension/hyperflexion of limbs
Provisional diagnosis
 Clinical

 Environmental (food, housing, water,

sanitation)

 Socio- economic (education, poverty,

family size)
Investigations
Hemoglobin, Total Count/Differential
Count, blood smear and microscopy
Blood glucose, electrolytes,
Urine routine examination and culture,
Stool for ova and parasites
Serum albumin, HIV test
Chest X-ray, etc.
Management

1. Clinical management based on presenting illness, along with

regular follow up.
2. Environmental improvement; Health education, nutritional
education.
3. Socio-economic conditions: promotion of education and literacy,
identification of income generation activities and counseling.