Malnutrition in children in resource-limited countries: Clinical assessment
- Praveen S Goday, MBBS
Praveen S Goday, MBBS
- Professor, Pediatric Gastroenterology and Nutrition
- Medical College of Wisconsin, Milwaukee, WI
- Section Editors
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
- B UK Li, MD
B UK Li, MD
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- Medical College of Wisconsin
Undernutrition is a critical determinant of mortality and morbidity in young children worldwide; it is associated with 45 percent of all deaths in children under five years of age [1,2]. Severe undernutrition is primarily a problem in resource-limited countries. Globally, childhood stunting decreased from 39.7 percent in 1990 to 23.2 percent in 2015, and is expected to decline further . However, the trends vary by region: stunting rates in Asia have shown dramatic declines but have continued to increase in Africa . Severe undernutrition is uncommon in the United States.
In this topic review we use the term "malnutrition" in its traditional sense, referring to undernutrition (wasting, stunting, or micronutrient deficiencies), although some authors use the term more broadly, to encompass overnutrition/obesity.
The major forms of malnutrition are marasmus (wasting) and kwashiorkor (edematous malnutrition), with or without associated stunting. The clinical assessment of the child with malnutrition includes distinguishing between these types, assessing their severity, 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".)
Clinical findings in children with chronic undernutrition usually include diminished height (stunting), as well as poor weight gain and deficits in both lean body mass and adipose tissue. Other features include reduced physical activity, mental apathy, and retarded psychomotor and mental development [4-6].
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- CHRONIC MALNUTRITION
- ACUTE MALNUTRITION
- Clinical subtypes
- - Marasmus
- - Kwashiorkor (edematous malnutrition)
- CLINICAL ASSESSMENT
- - Z-scores
- - Mid-upper arm circumference
- Diagnostic criteria
- Children 6 through 59 months
- - Infants <6 months
- ADMISSION AND DISCHARGE CRITERIA
- EVALUATION FOR COMORBID CONDITIONS
- Distinguishing sepsis from dehydration
- Diarrhea and dehydration
- - Definitions and types of diarrhea
- - Evaluation for dehydration
- Other infections
- Dermatosis of kwashiorkor
- SPECIFIC NUTRIENT DEFICIENCIES
- SUMMARY AND RECOMMENDATIONS