Sometimes children who eat a balanced diet suffer from malnutrition. The reason for this may be malabsorption, the body’s inability to absorb nutrients from the digestive system into the bloodstream.
Normally the digestive process converts nutrients from the diet into small units that pass through the wall of the intestine and into the bloodstream, where they are carried to other cells in the body. If the intestinal wall is damaged by a virus, bacterial infection, or parasites, its surface may change so that digested substances cannot pass through. When this happens, the nutrients will be eliminated through the stool.
Malabsorption commonly occurs in a normal child for a day or two during severe cases of stomach or intestinal flu. It rarely lasts much longer since the surface of the intestine heals quickly without significant damage. In these cases, malabsorption is no cause for concern. However, chronic malabsorption may develop, and if two or more of the following signs or symptoms persist, notify your pediatrician.
Signs and Symptoms
Possible signs and symptoms of chronic malabsorption include the following:
- Persistent abdominal pain and vomiting
- Frequent, loose, bulky, foul- smelling stools
- Increased susceptibility to infection
- Weight loss with the loss of fat and muscle
- Increase in bruises
- Bone fractures
- Dry, scaly skin rashes
- Personality changes
- Slowing of growth and weight gain (may not be noticeable for several months)
When a child suffers from malnutrition, malabsorption is just one of the possible causes. She might be undernourished because she’s not getting enough of the right types of food, or she has digestive problems that prevent her body from digesting them. She also might have a combination of these problems. Before prescribing a treatment, the pediatrician must determine the cause. This can be done in one or more of the following ways.
- You may be asked to list the amount and type of food your child eats.
- The pediatrician may test the child’s ability to digest and absorb specific nutrients. For example, the doctor might have her drink a solution of milk sugar (lactose) and then measure the level of hydrogen in her breath afterward. This is known as a lactose hydrogen breath test.
- The pediatrician may collect and analyze stool samples. In healthy people, only a small amount of the fat consumed each day is lost through the stool. If too much is found in the stool, it is an indication of malabsorption.
- Collection of sweat from the skin, called a sweat test, may be performed to see if cystic fibrosis is present. In this disease, the body produces insufficient amounts of certain enzymes necessary for proper digestion and an abnormality in the sweat.
- In some cases the pediatrician might request that a pediatric gastroenterologist obtain a biopsy from the wall of the small intestine, and have it examined under the microscope for signs of infection, inflammation, or other injury.
Ordinarily, these tests are performed before any treatment is begun, although a seriously sick child might be hospitalized in order to receive special feedings while her problem is being evaluated.
Once the physician is sure the problem is malabsorption, she will try to identify a specific reason for its presence. When the reason is infection, the treatment usually will include antibiotics. If malabsorption occurs because the intestine is too active, certain medications may be used to counteract this, so that there’s time for the nutrients to be absorbed.
Sometimes there’s no clear cause for the problem. In this case, the diet may be changed to include foods or special nutritional formulas that are more easily tolerated and absorbed.