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 — Gastroenterology
- Professor of Pediatrics
- Medical College of Wisconsin
Malnutrition is the most important determinant of mortality and morbidity in young children worldwide; it is associated with 50 percent of all deaths in children under five years of age [1-4]. Severe malnutrition is primarily a problem in resource-limited countries. Globally, childhood stunting due to malnutrition decreased from 39.7 percent in 1990 to 26.7 percent in 2010 and is expected to decline further. However, the trends vary by region: stunting rates in Asia have shown dramatic declines but have stagnated in Africa . Severe malnutrition is uncommon in the United States.
The clinical assessment of the child with malnutrition includes distinguishing between marasmus and edematous malnutrition (traditionally known as 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".)
Clinical findings in children with chronic undernutrition usually include poor weight gain, diminished height, and deficits in both lean body mass and adipose tissue. Other features include reduced physical activity, mental apathy, and retarded psychomotor and mental development [6,7].
Severe protein-energy malnutrition is associated with one of two classical syndromes: marasmus (wasting syndrome) and edematous malnutrition (or kwashiorkor). 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 (or show a decrease in weight-for-length or body mass index), whereas children with chronic malnutrition have stunted linear growth. Malnourished children also suffer from numerous associated complications, including dehydration, infection, and vitamin deficiencies (table 1). (See 'Evaluation for comorbid conditions' below and 'Specific nutrient deficiencies' below.)
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- PROTEIN-ENERGY MALNUTRITION
- Clinical subtypes
- - Marasmus
- - Edematous malnutrition (kwashiorkor)
- ASSESSMENT OF SEVERITY
- WHO definitions
- - Calculators
- Mid-upper arm circumference
- Other methods
- 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