Malnutrition: Widni’s Story

If you met Widni today, you’d probably never suspect the long, uphill battle she and her family faced to get to this point.

Born in the Dominican Republic where her family lives, Widni was fortunate enough to receive regular medical check-ups as part of the Niños Primeros en Salud (NPS) program, a unique collaboration between the Children’s Hospital of Philadelphia (CHOP) and Centro de Salud Divina Providencia, a hospital in Consuelo, Dominican Republic. As part of the partnership, doctors from CHOP’s Global Health Center provide comprehensive pediatric care and health education to the most impoverished children and families in the barrios of Consuelo.

Health concerns from infancy

Doctors were concerned about Widni from an early age. As a baby, she was often sick — despite being up -to- date on her vaccines and being almost exclusively breastfed. Her mother, Altagracia, often brought the baby into the Niños Primeros en Salud clinic to be examined for breathing and respiratory issues.

Ingrid Japa, MD, a pediatrician with the NPS program, noticed a pattern in the family’s monthly appointments: in addition to Widni’s respiratory symptoms, the baby’s weight was also fluctuating. Generally, children gain weight as they grow, but by age 2, Widni was losing weight. This was a troubling symptom of what would become a much more complex condition: malnutrition.

“When a child doesn’t eat enough, it leaves her more susceptible to infection and illness,” Dr. Japa says. “And the more a child is ill, the more she loses weight and becomes malnourished. It creates a vicious cycle.”

Widni was sick so often because her body did not have the same ability to fight off infection as a well-nourished child’s body would. What’s more, as is common with children dealing with malnutrition, she had little appetite, which only aggravated her condition and the complications she was experiencing.

A diagnosis — and a treatment plan

The diagnosis of malnutrition was scary at first for Widni’s mother. “I felt so sad, and I didn’t know what was happening to my daughter,” she remembers. But Altagracia quickly realized that by identifying her daughter’s underlying medical issue, Widni’s medical team — which included pediatricians, nurses, community health workers and her family — could work together to solve it.

Widni was enrolled in the Niños Primeros en Salud nutrition program, which provides a monthly food supplement packet and intensive follow-up to help reinforce a diet that includes nutritionally dense foods like oats, peanut butter and tuna. Widni was prescribed vitamin A and iron supplements to boost her immune system, and a deworming medication to rid her of any parasites that might be contributing to her malnutrition.

In addition to Widni’s treatment and monthly follow-up visits, the NPS program also educated her family about proper nutrition and feeding practices for children, as well as warning signs of malnutrition.

“I started to feel calmer about Widni’s situation when the doctors explained things to me,” Altagracia says. “They told me all about the most nutritious foods to feed my daughter, and that I should feed her every two hours.”

Slow progress

The road to recovery was slow, however. Widni continued to visit the clinic with frequent respiratory symptoms and ear infections. Each time, the clinical team approached Widni’s case holistically by treating the latest symptoms or infections, while thinking about malnutrition as an underlying cause that also required close follow-up.

Over the next year of regular medical attention from her clinical team and her mother who faithfully brought her to every appointment and absorbed the education provided, Widni slowly got stronger.

Her infections became less frequent, and her malnutrition diagnosis progressed from moderate to light. Widni was eating three solid meals each day, plus two snacks, and had a good appetite. Her health was finally improving.

Positive results

Three months later, it was time for Widni’s regular consultation at the Niños Primeros en Salud clinic. At 3 years old, her weight and height were finally within normal ranges. Her family and medical team were elated.

Dr. Japa celebrated the outcome, saying: “We were proud to see that she was finally on track for normal development and good health. What’s more, she and her family came out of this with good knowledge of nutrition. She went from being a sick patient to a healthy one, and her family is so happy.”

Perhaps no one was happier than Widni’s biggest advocate – her mom. “I feel so much better and calmer now that she is healthy,” Altagracia says. “Widni is eating more, and she is eating a greater variety thanks to this program.”

The long trajectory of care was worth it for the excellent result, Dr. Japa says.

“Ultimately, it was the regular follow-up — combined with the fact that Widni’s mother never missed a consultation — that brought her back to good health,” Dr. Japa says. “It takes time to learn and change behaviors, but with consistent contact and education, we were able to work as a team to bring about a positive result.”

Now a healthy 5-year-old, Widni is graduating from the Niños Primeros en Salud nutrition program and getting ready for her next big adventure: kindergarten.