Malnutrition in children in resource-limited countries: Clinical assessment
- Buford L Nichols, MD
Buford L Nichols, MD
- Emeritus Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- William J Klish, MD
William J Klish, MD
- Section Editor — Pediatric Gastroenterology
- Emeritus Professor of Pediatrics
- Baylor College of Medicine
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
Severe malnutrition is primarily a problem in resource-limited countries. Severely malnourished children typically are brought to medical attention when a health crisis, such as an infection, precipitates the transition between marasmus (a state of nutritional adaptation) and kwashiorkor, in which adaptation is no longer adequate.
The clinical assessment of the child with malnutrition includes distinguishing between marasmus and kwashiorkor, assessing the severity of the malnutrition, and identifying acute life-threatening complications, including sepsis and acute dehydration. These children are at risk for micronutrient deficiencies, as detailed in a separate topic review. (See "Micronutrient deficiencies associated with malnutrition in children".)
Treatment of severe malnutrition is discussed separately. (See "Severe malnutrition in children in resource-limited countries: Treatment".)
Severe malnutrition is uncommon in the United States. Clinical findings in children with chronic undernutrition usually include diminished height, poor weight gain, and deficits in lean body mass and adipose tissue. Other features include reduced physical activity, mental apathy, and retarded psychomotor and mental development [1,2].
Worldwide, severe protein-energy malnutrition (PEM) is a leading cause of death among children younger than five years of age. Severe protein-energy malnutrition is associated with one of two classical syndromes, marasmus (wasting syndrome) and kwashiorkor, or with manifestations of both. Each type of protein-energy malnutrition may be classified as acute or chronic, depending upon the duration of nutritional deprivation. Children with acute malnutrition appear wasted, whereas children with chronic malnutrition have stunted linear growth. Malnourished children also suffer from numerous associated complications. They are more susceptible to infection, especially sepsis, pneumonia, and gastroenteritis. Vitamin deficiencies and deficiencies of minerals and trace elements can also be seen (table 1) .
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- PROTEIN-ENERGY MALNUTRITION
- Clinical subtypes
- - Marasmus
- - Kwashiorkor
- - Mixed marasmus-kwashiorkor
- ASSESSMENT OF SEVERITY
- WHO definitions
- - Calculators
- Percent of median method
- Arm/head circumference
- Mid upper arm circumference
- Common features of dehydration and septic shock
- Distinguishing sepsis from dehydration
- - Evidence of dehydration
- - Evidence of septic shock
- DIARRHEA AND DEHYDRATION
- Dehydration in the well-nourished child
- Dehydration in the severely malnourished child
- OTHER INFECTIONS
- DERMATOSIS OF KWASHIORKOR
- SPECIFIC NUTRIENT DEFICIENCIES
- SUMMARY AND RECOMMENDATIONS