Assessment at admission

Take a history concerning

  • Recent intake of food and fluids
  • Usual diet (before the current illness)
  • Breastfeeding
  • Duration and frequency of diarrhoea and vomiting
  • Type of diarrhoea (watery/bloody)
  • Chronic cough
  • Loss of appetite
  • Family circumstances (to understand the child’s social background)
  • Contact with tuberculosis
  • Recent contact with measles
  • Known or suspected HIV infection.
  • Immunizations

On examination, look for

  • Anthropometry- weight, height/length, mid arm circumference
  • Oedema
  • Pulse, heart rate, respiratory rate
  • Signs of dehydration
  • Shock (cold hands, slow capillary refill, weak and rapid pulse)
  • Palmar pallor
  • Eye signs of vitamin A deficiency:
    • Dry conjunctiva or cornea,
    • Bitot’s spots
    • Corneal ulceration
    • Keratomalacia
  • Localizing signs of infection, including ear and throat infections, skin infection or pneumonia
  • Mouth ulcers
  • Skin changes of kwashiorkor:
    • Hypo or hyperpigmentation
    • Desquamation
    • Ulceration (spreading over limbs, thighs, genitalia, groin, and behind the ears)
    • Exudative lesions (resembling severe burns) often with secondary infection (including Candida).