Malnutrition is a condition that develops when the body does not get the
proper amount of protein, energy (calories),
, and other nutrients it needs to maintain healthy tissues and organ
Poor eating habits or lack of available food may lead to malnutrition.
Malnutrition occurs in children who are either undernourished or
overnourished. Children who are overnourished may become overweight or
obese, which may lead to long-term health problems and social stress.
Undernutrition is a consequence of consuming little energy and other
essential nutrients, or using or excreting them more rapidly than they can
be replaced. This state of malnutrition is often characterized by
infections and disease. Malnutrition intensifies the effect of every
disease. Severe malnutrition is most often found in developing countries.
Rarely in the United States do children suffer from severe malnutrition
that is not related to severe chronic illness. Deficiency in one nutrient
occurs less often than deficiency in several nutrients. A child suffering
from malnutrition is usually deficient in a variety of nutrients.
The leading cause of death in children in developing countries is
. This type of malnutrition is the result of inadequate intake of protein
and energy. Children who are already undernourished can suffer from
protein-energy malnutrition when rapid growth, infection, or disease
increases the need for protein and essential nutrients.
In the United States, nutritional deficiencies have generally been
replaced by dietary imbalances or excesses
associated with many of the leading causes of death and disability.
Overnutrition results from eating too much, eating too many of the wrong
foods, not exercising enough, or taking too many vitamins or other dietary
Risk of overnutrition is also increased by being more than 20 percent
overweight, consuming a diet high in fat and salt, and taking high doses
Nutritional disorders can affect any system in the body and the senses of
sight, taste, and smell. Malnutrition begins with changes in nutrient
levels in blood and tissues. Alterations in enzyme levels, tissue
abnormalities, and organ malfunction may be followed by illness and death.
Poorly nourished children often have weakened immune systems, thus
increasing their chances of illness. Underweight, malnourished teenagers
(such as those with an eating disorder) have an increased risk of
osteoporosis and may not have menstrual periods. They may have heart and
other organ problems with severe malnutrition. Malnutrition, if left
untreated, can lead to physical or mental disability, or even death.
Children who are overweight have an increased risk for long-term
conditions and diseases, including cardiovascular disease,
, high blood pressure, type 2 diabetes,
apnea, and certain cancers. Health consequences range from a higher risk
of premature death to chronic conditions that reduce a person's
quality of life.
Malnutrition is a major cause of illness and death throughout the world.
Throughout the developing world, malnutrition affects almost 800 million
people, or 20 percent of the population. Approximately half of the 10.4
million children who die each year are malnourished. It often causes
disease and disability in the children who survive. Diarrheal diseases are
also a major world health problem, and may be a cause of malnutrition.
Nearly all of these deaths occur in impoverished parts of Africa and Asia,
where they often result from contamination of the water supply by animal
and human feces.
Worldwide, the most common form of malnutrition is iron deficiency,
affecting up to 80 percent of the population, as many as four or five
In contrast, children in many parts of the world are becoming increasingly
overweight. What was thought of as a problem for industrialized nations
only until recently, is now affecting children in developing countries.
Approximately 25–30 percent of school-age children in the United
States are overweight.
Causes and symptoms
Worldwide, poverty and lack of food are the primary reasons why
malnutrition occurs. Families of low-income households do not always have
enough healthy food to eat. When there is a household food shortage,
children are the most vulnerable to malnutrition because of their high
There is an increased risk of malnutrition associated with chronic
diseases, especially disease of the intestinal tract, kidneys, and liver.
Children with chronic diseases like
, and intestinal disorders may lose weight rapidly and become susceptible
to malnutrition because they cannot absorb valuable vitamins, iron, and
other necessary nutrients. Children who are lactose intolerant have
difficulty digesting milk and milk products, and may be at risk for
malnutrition, particularly a calcium deficiency.
Symptoms of malnutrition vary, depending on what nutrients are deficient
in the body. Unintentionally losing weight may be a sign of malnutrition.
Children who are malnourished may be skinny or bloated and may be short
for their age (stunted). Their skin is pale, thick, dry, and easily
and changes in pigmentation are common.
Hair is thin, tightly curled, and easily pulled out. Joints ache and bones
are soft and tender. The gums bleed. The tongue may be swollen, or
shriveled and cracked. Visual disturbances include night blindness and
increased sensitivity to light and glare.
Other symptoms of malnutrition include:
Children who are overnourished are visibly overweight or obese, and
consume more food than their bodies need (or expend too little energy
through physical activity).
Parents who worry about malnutrition can discuss their concerns with a
doctor, registered dietitian, or other health care provider. Though not an
exhaustive list, treatment should be sought for a child if:
Overall appearance, behavior, body-fat distribution, and organ function
can alert a
physician, internist, or
specialist to the presence of malnutrition. Parents may be asked to
record what a child eats during a specific period.
or a CT scan can determine bone density and reveal gastrointestinal
disturbances, as well as heart and lung damage.
Blood and urine tests are used to measure levels of vitamins, minerals,
and waste products. Nutritional status can also be determined by:
Normalizing nutritional status starts with a nutritional
. This process enables a registered dietitian or nutritionist to confirm
the presence of malnutrition, assess the effects of the disorder, and
formulate a diet that will restore adequate nutrition. For children
suffering malnutrition due to an illness or underlying disorder, the
condition should be treated concurrently.
Children who cannot or will not eat, or who are unable to absorb nutrients
taken by mouth, may be fed
Child suffering from the severe effects of malnutrition.
(Photograph by Bruce Brander. National Audubon Society
Collection/Photo Researchers, Inc.)
intravenously (parenteral nutrition) or through a tube inserted into the
gastrointestinal tract (enteral nutrition).
Tube feeding is often used to provide nutrients to children who have
, inflammatory bowel disease, or other long-term conditions that cause
chronic malnutrition or malabsorption (e.g. cystic fibrosis or AIDS), and
interfere with the ability to take in enough calories. This procedure
involves inserting a thin tube through the nose and carefully guiding it
along the throat until it reaches the stomach or small intestine. If
long-term tube feeding is necessary, the tube may be placed directly into
the stomach or small intestine through an incision in the abdomen.
Tube feeding cannot always deliver adequate nutrients to children who:
Intravenous feeding can also supply some or all of the nutrients these
Doctors or registered dietitians can help parents can monitor overweight
or obese children. These professionals may suggest a weight loss program
if the child is more than 40 percent overweight. Keeping weight gain under
control can be accomplished by changing eating habits, lowering fat
intake, and increasing physical activity.
Some children with protein-energy malnutrition recover completely. Others
have many health problems throughout life, including mental disabilities
and the inability to absorb nutrients through the intestinal tract.
Prognosis is dependent on age and the length and severity of the
malnutrition, with young children having the highest rate of long-term
complications and death. Death usually results from heart failure,
electrolyte imbalance, or low body temperature. Children with
semiconsciousness, persistent diarrhea,
, or low blood sodium levels have a poorer prognosis.
A good prognosis exists for overweight children who make lifestyle changes
and adhere to a diet and
Every child admitted to the hospital for poor weight gain or malnutrition
should be screened for the presence of illnesses and conditions that could
lead to protein-energy malnutrition. Children with higher-than-average
risk for malnutrition should be more closely assessed, and evaluated
—A condition in which there is an abnormally low number of red
blood cells in the bloodstream. It may be due to loss of blood, an
increase in red blood cell destruction, or a decrease in red blood cell
production. Major symptoms are paleness, shortness of breath, unusually
fast or strong heart beats, and tiredness.
—Salts and minerals that produce electrically charged particles
(ions) in body fluids. Common human electrolytes are sodium chloride,
potassium, calcium, and sodium bicarbonate. Electrolytes control the
fluid balance of the body and are important in muscle contraction,
energy generation, and almost all major biochemical reactions in the
—Inorganic chemical elements that are found in plants and animals
and are essential for life. There are two types of minerals: major
minerals, which the body requires in large amounts, and trace elements,
which the body needs only in minute amounts.
—Substances in food that supply the body with the elements needed
for metabolism. Examples of nutrients are vitamins, minerals,
carbohydrates, fats, and proteins.
—Small compounds required for metabolism that must be supplied by
diet, microorganisms in the gut (vitamin K) or sunlight (UV light
converts pre-vitamin D to vitamin D).
Infants, young children, and teenagers need additional nutrients to
provide for growth requirements. This is also true for women who are
pregnant or breastfeeding; a mother's nutritional status affects
her baby. Nutrient loss can be accelerated by diarrhea, excessive
sweating, heavy bleeding (hemorrhage), or kidney failure. Nutrient intake
can be restricted by age-related illnesses and conditions, excessive
dieting, severe injury,
serious illness, a lengthy
, or substance abuse.
Children usually eat as much or as little as they need in order to feel
satisfied. Children should be allowed to select what they want to eat
among healthy food choices; they should be allowed to stop eating when
they feel full. An underweight, overweight, or normal weight child should
be allowed to decide how much to eat or whether to eat at all, within
Parents must proactively prevent childhood
by recognizing weight imbalances when they begin. They can help an
overweight child to lose weight (if medically necessary) by being
supportive, rather than scolding. Parents should offer their children
nutritious food choices and encourage physical activity. With proper
intervention, an overweight child is not destined to become an overweight
adult, but weight loss goals should be realistic.
Kleinman, Ronald E., and the American Academy of Pediatrics Committee on
Pediatric Nutrition Handbook,
5th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2003.
Physicians Committee for Responsible Medicine.
Eating for Life for Children.
Hoboken, NJ: Wiley, 2002.
Willett, Walter C., and P.J. Skerrett.
Eat, Drink, and Be
Healthy: The Harvard Medical School Guide to Healthy Eating.
New York: Simon & Schuster Source, 2002.
American Academy of Pediatrics.
141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098. (847)
American College of Emergency Physicians.
1125 Executive Circle, Irving, TX 75038-2522. (800) 798-1822.
American College of Nutrition.
300 S. Duncan Ave. Ste. 225, Clearwater, FL 33755. (727) 446-6086.
American Dietetic Association.
120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. (800)
Food and Nutrition Information Center.
Agricultural Research Service, USDA, National Agricultural Library, Room
105, 10301 Baltimore Boulevard, Beltsville, MD 20705-2351. Web site: