11.6.3: Malnutrition

Learning Objectives

1. Define milk anemia, marasmus, and kwashiorkor.
2. Identify the symptoms and causes of severe malnutrition disorders.
3. Explain the long-term effects of early childhood malnutrition on cognitive and behavioral development.
4. Describe the signs, causes, and implications of failure to thrive (FTT) in infants and toddlers.

Child Malnutrition

There can be serious effects on children when there are deficiencies in their nutrition. Let’s explore a few types of nutritional concerns.

Wasting

Children in developing countries and countries experiencing the harsh conditions of war are at risk for two major types of malnutrition, also referred to as wasting. Infantile marasmus refers to starvation due to a lack of calories and protein. Children who do not receive adequate nutrition lose fat and muscle until their bodies can no longer function. Babies who are breastfed are much less at risk of malnutrition than those who are bottle-fed.

After weaning, children who have diets deficient in protein may experience kwashiorkor or the “disease of the displaced child,” often occurring after another child has been born and taken over breastfeeding. This results in a loss of appetite and swelling of the abdomen as the body begins to break down the vital organs as a source of protein.

Around the world, the rates of wasting have been dropping. However, according to the World Health Organization and UNICEF, in 2014, there were 50 million children under the age of five who experienced these forms of wasting, and 16 million were severely wasted (UNICEF, 2015). Worldwide, these figures indicate that nearly 1 child in every 13 suffers from some form of wasting. The majority of these children live in Asia (34.3 million) and Africa (13.9 million). Wasting can occur as a result of severe food shortages, regional diets that lack certain proteins and vitamins, or infectious diseases that inhibit appetite (Latham, 1997).

Figure \(\PageIndex{1}\): A child suffering from wasting. Image by the CDC is in the public domain.

The consequences of wasting depend on how late in the progression of the disease parents and guardians seek medical treatment for their children. Unfortunately, in some cultures, families do not seek treatment early, and as a result, by the time a child is hospitalized, the child often dies within the first three days after admission (Latham, 1997). Several studies have reported long-term cognitive effects of early malnutrition (Galler & Ramsey, 1989; Galler, Ramsey, Salt & Archer, 1987; Richardson, 1980), even when home environments were controlled (Galler, Ramsey, Morley, Archer & Salt, 1990). Lower IQ scores (Galler et al., 1987), poor attention (Galler & Ramsey, 1989), and behavioral issues in the classroom (Galler et al., 1990) have been reported in children with a history of serious malnutrition in the first few years of life. ⁴¹

Milk Anemia

Milk Anemia in the United States: About 9 million children in the United States are malnourished (Children’s Welfare, 1998). Many more still suffer from milk anemia, a condition in which excessive milk consumption leads to a deficiency of iron in the diet. This can be due to the practice of giving toddlers milk as a pacifier, such as when resting, riding, or waking up. Appetite declines somewhat during toddlerhood, and a small amount of milk (especially with added chocolate syrup) can easily satisfy a child’s appetite for many hours. The calcium in milk also interferes with the absorption of iron in the diet. Many preschools and daycare centers offer toddlers a drink after they have finished their meal to prevent spoiling their appetites. ⁴²

Failure to Thrive

Failure to thrive (FTT) occurs in children whose nutritional intake is insufficient for supporting normal growth and weight gain. FTT typically presents before the age of two, when growth rates are at their highest. Parents may express concern about picky eating habits, poor weight gain, or a smaller size compared to peers of similar age. Physicians often identify FTT during routine office visits, when a child's growth parameters are not aligning with growth curves.

Figure \(\PageIndex{2}\): FTT is often identified during routine pediatric office visits. Image by OPENPediatrics and Anne Marie K McFee is licensed CC BY-NC-ND 4.0.

FTT can be caused by physical or mental issues within the child (such as errors of metabolism, acid reflux, anemia, diarrhea, Cystic fibrosis, Crohn’s disease, celiac disease, cleft palate, tongue tie, milk allergies, hyperthyroidism, congenital heart disease, etc.) It can also be caused by caregivers’ actions (environmental), including an inability to produce enough breastmilk, inadequate food supply, providing an insufficient number of feedings, and neglect. These causes may also co-exist. For instance, a child who is not receiving sufficient nutrition may appear content, so caregivers do not offer feedings of sufficient frequency or volume. Similarly, a child with severe acid reflux who appears to be in pain while eating may make a caregiver hesitant to offer sufficient feedings.⁴³

References, Contributors and Attributions

41. Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0

42. Children’s Development by Ana R. Leon is licensed under CC BY 4.0

43. Failure to Thrive by Wikipedia is licensed under CC BY-SA 3.0

Children’s Welfare League of America. (1998). Child health fact sheet. https://www.cwla.org

Galler, J. R., & Ramsey, F. (1989). A follow-up study of the effects of early malnutrition on subsequent cognitive performance. Journal of the American Academy of Child & Adolescent Psychiatry, 28(4), 548–553. https://doi.org/10.1097/00004583-198907000-00012

Galler, J. R., Ramsey, F., Morley, D., Archer, E., & Salt, P. (1990). The long-term effects of early kwashiorkor compared with marasmus. American Journal of Public Health, 80(6), 676–681. https://doi.org/10.2105/AJPH.80.6.676

Galler, J. R., Ramsey, F., Salt, P., & Archer, E. (1987). Long-term effects of early kwashiorkor compared with marasmus: II. Language functioning. Journal of the American Academy of Child & Adolescent Psychiatry, 26(5), 636–644. https://doi.org/10.1097/00004583-198709000-00006

Latham, M. C. (1997). Human nutrition in the developing world (FAO Food and Nutrition Series, No. 29). Food and Agriculture Organization of the United Nations. https://www.fao.org/3/w0073e/w0073e00.htm

Richardson, S. A. (1980). The behavior of children with early histories of protein-energy malnutrition. In D. A. Hamburg & H. K. Brodie (Eds.), American Handbook of Psychiatry (Vol. 7, pp. 369–383). Basic Books.

UNICEF. (2015). Levels and trends in child malnutrition. https://data.unicef.org/resources/le...-malnutrition/