American Journal of Clinical Nutrition, Vol 5, 506-515, Copyright © 1957 by The American Society for Clinical Nutrition, Inc.

Treatment of Severe Protein Deficiency in Children (Kwashiorkor)

¹ Associate Director and Head of the Kwashiorkor study project, Institute of Nutrition of Central America and Panama (INCAP), Guatemala, C. A.
² Research fellow, INCAP
³ Regional Advisor in Nutrition, Pan American Sanitary Bureau, Regional Office for the Americas of the World Health Organization, and Director of INCAP

Detailed suggestions for the treatment of children with severe protein malnutrition (kwashiorkor) are given. These include attention to the fluid and electrolyte imbalances which are likely to characterize the acute case due to secondary complications and instructions for beginning treatment with frequent feedings of milk diluted to half strength. One to 2 g of protein and 30 to 60 cal per kg are given in the first 24 hours and the strength and amount of milk increased to provide 5 g of protein and 100 cal per kg by the end of the first week. Bananas, fruit juice, meat, eggs, vegetables, and cereals are gradually added to give a diet throughout most of the recovery period containing 5 to 7 g of protein and 130 to 150 cal.

Penicillin is given routinely for the first eight to ten days and supplementary iron therapy is started after one week has elapsed. Vitamin A is given when serious ocular lesions are present and whole blood transfusion may be necessary in the rare case of collapse, shock, or severe anemia; no other vitamins or minerals and no special enzyme or lipotropic preparations are indicated. The importance of protection from infection and the need for sympathetic and understanding care are stressed. The cost of hospitalization of kwashiorkor cases can be drastically reduced by eliminating the use of costly proprietary preparations and by greatly shortening the hospital stay through close attention to the principles of treatment described.