Clinical Manifestation Of Malnutrition in Children

Clinical Manifestation Of Malnutrition in Children

Malnutrition is directly responsible for 300,000 deaths per year in children younger than 5 years in developing countries and contributes indirectly to more than half of all deaths in children worldwide.


Clinical signs and symptoms of protein-energy malnutrition (PEM) include the following:

  • Poor weight gain
  • Slowing of linear growth
  • Behavioral changes: Irritability, apathy, decreased social responsiveness, anxiety, and attention deficits

The most common and clinically significant micronutrient deficiencies and their consequences include the following:

  • Iron: Fatigue, anemia, decreased cognitive function, headache, glossitis, and nail changes
  • Iodine: Goiter, developmental delay, and mental retardation
  • Vitamin D: Poor growth, rickets, and hypocalcemia
  • Vitamin A: Night blindness, xerophthalmia, poor growth, and hair changes
  • Folate – Glossitis, anemia (megaloblastic), and neural tube defects (in fetuses of women without folate supplementation)
  • Zinc: Anemia, dwarfism, hepatosplenomegaly, hyperpigmentation and hypogonadism, acrodermatitis enteropathica, diminished immune response, and poor wound healing

Physical examination

Physical findings that are associated with PEM include the following  :

  • Decreased subcutaneous tissue: Areas that are most affected are the legs, arms, buttocks, and face
  • Edema: Areas that are most affected are the distal extremities and anasarca (generalized edema)
  • Oral changes: Cheilosis, angular stomatitis, and papillar atrophy
  • Abdominal findings: Abdominal distention secondary to poor abdominal musculature and hepatomegaly secondary to fatty infiltration
  • Skin changes: Dry, peeling skin with raw, exposed areas; hyperpigmented plaques over areas of trauma
  • Nail changes: Fissured or ridged nails
  • Hair changes: Thin, sparse, brittle hair that is easily pulled out and that turns a dull brown or reddish color
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