Question

A one and a half year old girl child, fed mostly on dilute cow's milk, develops diarrhea that continues for 10 days. She then develops swelling of both feet, and the picture is diagnosed as kwashiorkor. The most important aspect of her management is

• A. Diuretics
• B. Fluid restriction
• C. Diet with adequate calories and protein
• D. Potassium restriction

Hint:

Think about what is actually missing in a child fed only dilute cow's milk.

Answer 1

The Correct Option is C

This case describes a toddler who was mainly fed dilute cow's milk, which is low in protein for her needs. She then has diarrhea for 10 days and swelling in both feet. Swollen feet in a malnourished child points to low blood protein, and together with the poor diet history this fits kwashiorkor, a type of severe malnutrition where protein intake is far short of what the body needs even though calorie intake may look near normal.

1. Diuretics: The swelling is caused by low albumin pulling fluid into the tissues, not by the body holding excess fluid. Giving diuretics would strip away fluid and electrolytes from an already depleted child and would not treat the underlying protein shortage.
2. Fluid restriction: There is no fluid overload to treat here. Restricting fluids does not add the protein and calories the child is missing, and could add to the risk of dehydration from ongoing diarrhea.
3. Diet with adequate calories and protein: This treats the actual cause of the illness. Feeding is built up gradually with enough energy and good quality protein so the body can rebuild muscle, replace albumin, and clear the edema over time.
4. Potassium restriction: Malnourished children like this one are usually short of potassium, not excess in it, because of poor intake and ongoing diarrhea losses. Restricting potassium further would only add harm.

The correct step is feeding the child a diet with enough calories and protein, since this addresses the actual deficiency driving the illness and the edema.

Let's summarize:

• A toddler on dilute cow's milk with diarrhea and foot swelling points to kwashiorkor.
• The edema comes from low protein, not fluid excess, so diuretics and fluid restriction do not help.
• These children are usually potassium deficient, so restricting potassium is wrong.
• Correcting the protein and calorie deficit through diet is the key management step.

So the most important part of management is a diet with adequate calories and protein.