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Malnutrition is a huge problem throughout the world, and it worsens in disaster situations. Estimates are that malnutrition contributes to more than half (54%) of all deaths of children <5 years old worldwide (Fig. 33-1). It usually occurs in resource-poor situations. The keys are both to recognize it and to treat it effectively.

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Fig. 33-1.
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Causes of death in children, worldwide.

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Malnutrition can be identified using arm circumference or by comparing a child's height and weight with standard charts.

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Arm Circumference

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Measuring a child's arm circumference halfway between the point of the shoulder and the elbow can help to determine the degree of malnourishment. This technique is at least as good at predicting mortality from malnutrition as is a child's position on a weight/height growth chart. Arm circumference is measured, in centimeters, at the midpoint of the left upper arm. From 1 to 5 years of age, the mid-arm circumference remains fairly stable, because the increasing growth in muscle mass is balanced by a decrease in arm fat. The median value for this age group is 16.5 cm. In the first 12 months of life, arm circumference changes so rapidly that it is not a reliable indicator of malnutrition. And, while skin thickness over the scapula or triceps can be measured, this requires the use of calipers and provides little additional information.1

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To make the measurement, have the child keep the arm hanging straight down by his side (Fig. 33-2). If the arm circumference of a child between the ages of 1 and 5 years is below 12.5 cm, he is severely malnourished. If it is between 12.5 and 14 cm, he is moderately malnourished. Above 14 cm is normal.2,3

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Fig. 33-2.
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Measure the mid-upper arm circumference to assess malnutrition.

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If a measuring tape is not available, a marked piece of non-stretchable cloth or a string with knots at the appropriate distances can be used, although it may stretch a little. Another method is to use a strip of x-ray film. Scratch or paint the film at the 0-cm mark, and again at the 12.5-cm and 14-cm marks. For clarity, the area between the 0- and 12.5-cm marks can be colored red; the area between 12.5 and 14 cm, yellow; and the area above 14 cm, green.

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The classification of malnutrition is based on the child's position on the standard weight-height-for-age charts, which can be accessed at the Centers for Disease Control and Prevention: Growth Charts (www.cdc.gov/growthcharts/). Height (length for a supine infant) and weight can be measured using standard means or by the improvised methods described in Chapter 7, Vital Signs, Measurements, and Triage. The results can be interpreted using the Welcome ...

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