Diet Plan for PEM Child

What is PEM?

Protein-Energy Malnutrition (PEM) is a condition that occurs when there is a severe lack of protein and calories in the diet of your child. It leads to weight loss, weakened immune function, and stunted growth in children. PEM often results from inadequate food intake and can cause various health problems.

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Types of PEM (Protein-Energy Malnutrition)

There are two main varieties of Protein- Energy Malnutrition:

1. Kwashiorkor:

   This form of PEM occurs when there's a severe deficiency of protein in the diet, even if the overall calorie intake might be sufficient. It's most common in children who are weaned off breast milk and given a diet high in carbohydrates but low in protein. Symptoms include:

   • Edema: Swelling in the abdomen, legs, and sometimes face.

   • Ascites: Fluid accumulation in the abdominal cavity, causing a swollen belly.

   • Skin Changes: Skin may become dry, flaky, and discoloured.

   • Hair Changes: Hair may become thin, brittle, and discoloured.

   • Irritability: Children may be more irritable or lethargic.

2. Marasmus:

   This type of PEM results from a severe deficiency in both calories and protein. It is often due to extreme malnutrition, where the body doesn't get enough energy or nutrients. Symptoms include:

   • Extreme Emaciation: Very low body weight and muscle wasting.

   • Weakness: General weakness and fatigue, with little energy for physical activities.

   • Skin Changes: The skin may appear thin and wrinkled.

   • Growth Failure: Stunted growth and development in children.

   • Visible Bones: Bones may become more prominent due to a lack of body fat.

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Diet Plan for PEM Child

The following table lists a concise diet plan for a child with PEM (Protein-Energy Malnutrition), covering both vegetarian and non-vegetarian options:

Feel free to adjust portions based on the child's specific nutritional needs and preferences.

Recommended Foods for a PEM Child

For a child with Protein-Energy Malnutrition (PEM), it's important to provide foods that are rich in both protein and energy. Some of the recommended foods are as follows:

1. Energy

   • Sources: Cereals and starchy foods like oats, rice, and wheat flour.

   • Recommendation: Ensure your diet provides enough calories. Opt for malted cereals and natural sugars like stevia to boost calorie density.

2. Protein

   • Sources: Milk, dairy products, seafood, lean meat, eggs, and pulses.

   • Recommendation: Add protein-rich foods from both animal and plant sources. Use buttermilk or dal-based options if milk intolerance occurs.

3. Vitamin A

   • Sources: Egg yolk, milk, curd, butter, fortified foods, and fruits.

   • Recommendation: Include green, deep yellow, or orange vegetables to combat vision issues and growth retardation.

4. Vitamin C

   • Sources: Amla, oranges, tomatoes, lemons.

   • Recommendation: Enhances immune response and prevents infections. Supports collagen formation and acts as an antioxidant.

5. Vitamin B6 (Pyridoxine)

   • Sources: Lean meat, pulses, wheat, and other cereals.

   • Recommendation: Essential for the metabolism of proteins, carbohydrates, and fats. Helps with growth and development.

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Additional Essential Nutrients in the PEM Diet Plan 

1. Folic Acid

   • Sources: Liver, egg yolk, legumes, soy products, nuts, leafy vegetables, and fruits.

   • Recommendation: Essential for cell division and growth, particularly for infants and children.

2. Iron

   • Sources: Leafy greens (spinach), liver, meat or poultry, pulses, whole grains, jaggery.

   • Recommendation: Helps treat anaemia, which is common in PEM.

3. Calcium

   • Sources: Dairy products, egg whites, vegetables, fruits, nuts, and seafood.

   • Recommendation: Supports bone health.

4. Zinc

   • Sources: Unmilled grains and legumes.

   • Recommendation: Helps with growth, immune function, and preventing diarrhoea.

5. Fluid

   • Sources: ORS solution, plain water, dal liquid, tender coconut water.

   • Recommendation: Essential to prevent dehydration and restore electrolyte balance.

Foods to Avoid on a PEM Diet

• Sugary Snacks and Drinks: These can add extra calories without much nutrition and may worsen malnutrition.

• Processed Foods: Often lacking in essential nutrients and loaded with unhealthy fats and additives.

• High-Fat Foods: Too much fat can affect how your body absorbs nutrients and worsen malnutrition.

• Salty Foods: High salt content can make dehydration worse and affect overall health.

• Caffeinated Drinks: These can lead to dehydration and interfere with how your body absorbs nutrients.

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Useful Tips to Avoid Protein Energy Malnutrition

• Balanced Diet: Include a mix of cereals, proteins, fruits, and vegetables in each meal.

• Regular Meals: Ensure consistent meal times with adequate portions to meet energy needs.

• Nutrient-Dense Foods: Choose foods rich in essential vitamins and minerals, like leafy greens, nuts, and lean meats.

• Hydration: Drink plenty of fluids to stay hydrated and support overall health.

• Monitor Growth: Regularly check growth and development in children to catch any signs of malnutrition early.

• Avoid Empty Calories: Limit foods high in sugar and fat that provide calories without essential nutrients.

Best Practices: Do’s and Don’ts for PEM Management^~

1. Do’s for a PEM Child:

   • Get Medical Help: See a doctor or nutritionist right away if you suspect PEM. They can determine how severe it is and recommend the best treatment.

   • Eat Protein and Energy-Rich Foods: Include plenty of high-quality proteins like meat, eggs, fish, beans, and nuts. Also, focus on energy-dense foods such as whole grains, nuts, seeds, and healthy fats like avocado and olive oil.

   • Start Small: If you’re severely malnourished, begin with small amounts of food and gradually increase to avoid overwhelming your digestive system.

   • Address Underlying Issues: If there’s an underlying health problem causing malnutrition, make sure to treat that as well.

2. Don’ts for a PEM Child:

   • Don’t Cut Back on Food: Avoid restricting your food intake or trying to lose weight, as this can make malnutrition worse.

   • Skip Low-Nutrition Foods: Stay away from foods with little nutritional value, like candy, soda, and fried foods, which are high in sugar and unhealthy fats.

   • Don’t Overeat: Eating too much at once can overload your digestive system and cause discomfort. Instead, gradually increase your food intake as advised by your healthcare provider.

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Best Exercises for PEM Child^~

• Start Slow: Begin with gentle exercises like walking, basic yoga, or light resistance training. These activities help build strength and stamina without putting too much strain on your body.

• Increase Gradually: Slowly increase how long and how often you exercise to avoid overdoing it. It’s a good idea to work with a healthcare professional or fitness trainer to create a plan that’s right for you.

• Try Weightlifting: Light weight lifting or resistance exercises can help build muscle. Start with lighter weights and increase them gradually as you get stronger.

• Rest is Key: Make sure to get plenty of rest. People with PEM need more recovery time, so don’t push yourself too hard, or it could make things worse.

• Stay Hydrated: Drink lots of water before, during, and after exercise to stay hydrated and avoid dehydration.