Although it less common in developed countries, malnutrition is still an important condition that can adversely affect pediatric health. The effects of malnutrition, depending on the extent of the condition, can persist into adulthood. Malnutrition is most often manifested as undernutrition; however, overnutrition, frequently resulting in obesity, has also become a major threat to children in the United States. Because childhood is largely a period of physical growth and development, an awareness of the common signs of malnutrition, including various anthropometric signs, is critical for quickly correcting dietary abnormalities. Vitamin deficiencies and surpluses also contribute to malnutrition and need to be considered when discussing problems with nutrition.

Undernutrition is a concept that conjures up different meanings for patients and providers based upon a number of societal factors. Depending on whether the deficiency is protein, energy, or micronutrients: the signs, symptoms, intervention, and treatment strategies will be different. Some of the presenting signs of undernutrition include growth failure, low birth weight, signs of specific vitamin and nutrient deficiencies (Table 6.1), and infectious diseases. A nutritional assessment is primarily based on the physical exam. There are three primary anthropometric indices that are used to determine the general cause or extent of undernutrition: height for age, weight for age, and weight for height. Although these metrics are good for an initial assessment, they are only one component of a more thorough assessment to determine the patient’s nutritional status.

The deficiency of a single nutrient is often considered undernutrition. Typically, a deficiency in several nutrients leads to the term protein/ energy malnutrition (PEM). Primary PEM, which is more prevalent in developing countries, is related to inadequate food intake. Secondary PEM, which is more prevalent in developed countries, is concerned with increased nutrient requirements, increased nutrient losses, and decreased nutrient absorption. The two most severe forms of PEM, marasmus and kwashiorkor,

are typically considered as distinct disorders. Marasmus, also known as nonedematous PEM, is thought to result from inadequate energy intake, and it initially presents itself as a failure to gain weight, which is followed by weight loss. The skin then loses turgor and becomes loose as a result of the loss of subcutaneous fat. Muscle atrophy and hypotonia are also characteristic
signs. Kwashiorkor, also known as edematous PEM, presents with indistinct symptoms such as lethargy and apathy. In its advanced stage, kwashiorkor results in a loss of stamina, inadequate growth, muscle loss, increased susceptibility to infection, vomiting, diarrhea, and edema. It is worth noting that edema can develop early and conceal weight loss. Other common signs in edematous PEM are dermatitis, depigmentation, hair thinning and loss.