

Kwashiorkor in children is considered one of the most dangerous forms of malnutrition, as it directly affects a child’s growth and immune health. Children with this condition often experience symptoms such as swollen abdomen and limbs, muscle wasting, weakened immunity, and changes in hair and skin color.The main cause of kwashiorkor is a lack of protein in the diet. However, other factors such as vitamin and mineral deficiencies or early weaning can also increase the risk.In this Dalili Medical article, we’ll explore the causes of kwashiorkor, its key symptoms, and the latest and easiest treatment and nutrition options for children, so we can protect them and help them return to normal health and activity.
Kwashiorkor: Severe protein deficiency with some calorie intake. It usually shows as swelling in the abdomen or limbs, with less muscle loss compared to marasmus.
Marasmus: Deficiency of both protein and calories, leading to extreme weight and muscle loss, usually without swelling.
Yes, especially if the child is weaned too early or does not receive enough protein after breastfeeding.
Loss of appetite or refusal to eat.
Lethargy and low activity levels.
Mild swelling in the feet or abdomen.
Slight changes in hair color or texture.
No, Kwashiorkor is not contagious, but it weakens the immune system, making children more vulnerable to infections.
Yes, protein deficiency is the main cause. However, deficiencies in vitamins and minerals can worsen the condition.
Improvement usually begins within a few days of proper nutritional therapy, but full recovery of growth may take weeks or months depending on severity.
No. A balanced diet is the main treatment. Medicines and supplements only play a supportive role and cannot replace protein intake.
Weekly measurement of weight and height.
Observing the child’s activity and energy levels.
Regular blood tests to monitor protein, vitamin, and mineral levels.
Severe immune deficiency, making the child prone to infections.
Frequent, sometimes life-threatening infections.
Delayed physical and mental development.
Heart and liver complications in very severe cases.
Yes. Encouraging the child to eat and stay active improves overall recovery and reduces lethargy and irritability caused by malnutrition.
It is very rare, but possible in cases of chronic illness, severe malnutrition, or neglect.
Yes, most affected children also suffer from:
Recurrent diarrhea.
Frequent respiratory infections.
Chronic digestive problems that impair nutrient absorption.
Kwashiorkor is a severe form of protein-energy malnutrition. It occurs when a child consumes enough calories but not enough protein. The word Kwashiorkor comes from the Ga language in Ghana, meaning “the sickness of the older child when the next baby is born”, as it often affects older children after being weaned from breast milk.
This condition leads to edema (fluid retention), causing swelling in the abdomen and limbs. It also disrupts many body functions and can lead to life-threatening complications if not treated promptly.
Children between 1 and 4 years old in developing countries are the most affected, especially in regions where diets rely heavily on carbohydrates (like maize, rice, or cassava) with little protein.
According to UNICEF, nearly 50% of deaths in children under five are linked to malnutrition, and Kwashiorkor is one of the leading causes.
Adults can also develop Kwashiorkor, particularly those with absorption problems (e.g., HIV/AIDS patients) or those suffering from chronic neglect and severe malnutrition.
Although both Kwashiorkor and Marasmus are forms of severe malnutrition, they differ in cause and symptoms:
Kwashiorkor: Caused by protein deficiency despite adequate calorie intake. Leads to edema and fluid retention. Children may appear “puffy” with swollen abdomens and limbs.
Marasmus: Caused by a combined deficiency of both protein and calories. Leads to extreme muscle wasting and weight loss without edema. Children appear very thin and frail.
With early diagnosis and proper nutritional treatment, most children can recover their growth and development.
However, if Kwashiorkor occurs during critical stages of brain development, some children may suffer from long-term cognitive impairments.
Survivors may also face a higher risk of developing chronic diseases later in life, such as obesity, diabetes, and cardiovascular conditions.
Continuous monitoring and long-term support are essential to ensure the best health outcomes.
The word Kwashiorkor has African origins and literally means “the first and the second child.”
It refers to the fact that the first child often develops kwashiorkor when a second baby is born, because the newborn receives exclusive breastfeeding while the older child is weaned and no longer gets sufficient protein.
Kwashiorkor represents a severe protein deficiency (more than calorie deficiency), leading to serious problems in children’s growth and immune health.
Dietary protein deficiency
The direct cause of kwashiorkor.
Even if a child consumes enough calories (mainly from carbohydrates), lack of protein affects the production of antibodies and immune cells.
Deficiency of essential nutrients
Vitamins: A, D, E, K, C.
Minerals: Iron, zinc, selenium.
Their absence weakens the body’s resistance to infections.
Recurrent infections
Malnourished children are more vulnerable to diarrhea, respiratory infections, and viral or bacterial illnesses.
Inadequate or early cessation of breastfeeding
Early breastfeeding is essential for strengthening immunity.
Weaning too soon or introducing protein-poor foods after the first year can trigger kwashiorkor.
Chronic diseases or digestive disorders
Conditions such as liver or kidney disease, celiac disease, or chronic intestinal inflammation reduce the absorption of proteins and nutrients.
Poverty and lack of a balanced diet
Limited access to healthy, protein-rich food increases the risk of kwashiorkor.
Abdominal edema (swollen belly) due to protein deficiency and fluid retention.
Swelling of limbs: noticeable in hands, feet, and ankles.
Hair changes: thin, brittle, light-colored, sometimes yellowish or orange.
Muscle wasting: despite some body fat, the child looks very weak.
Skin changes: dryness, peeling, patches, or dark spots.
Recurrent infections (diarrhea, respiratory infections, skin infections).
Slow wound healing.
Increased susceptibility to even minor infections, which may cause serious complications.
Low activity and lethargy.
Irritability and severe mood swings.
Loss of appetite or food refusal.
Facial swelling, especially around the eyes.
Anemia, general weakness, and fatigue.
Digestive issues: constipation, recurrent diarrhea, gas, and bloating.
Classic Kwashiorkor
Most common type.
Symptoms: generalized swelling, brittle/yellowish hair, scaly skin with dark patches, weakness, low activity, and very weak immunity.
Marasmic Kwashiorkor
Occurs when both protein and calories are severely deficient.
Symptoms: extreme weight and muscle loss, mild to moderate swelling, severe damage to skin and hair.
Considered the most dangerous type for immunity due to combined protein-energy deficiency.
Subacute Kwashiorkor
Develops gradually.
Early symptoms: mild swelling, slight loss of appetite, initial hair and skin changes.
Immunity declines progressively before severe symptoms appear.
Secondary Kwashiorkor (disease-related)
Caused by chronic illnesses or malabsorption disorders (e.g., liver/kidney disease, celiac disease, chronic intestinal inflammation).
Symptoms resemble classic kwashiorkor but treatment must also address the underlying disease.
Immune system damage
Severe immune weakness, exposing the child to all types of infections—even mild ones.
Higher risk of diarrhea and recurrent respiratory infections.
Slow healing and recovery from illnesses.
Physical growth problems
Muscle loss and significant weight reduction.
Swelling of abdomen and limbs due to protein deficiency.
Stunted growth compared to peers.
Neurological and behavioral effects
Poor concentration and attention.
Extreme lethargy.
Mood changes, irritability, or depression in older children.
Skin and hair damage
Hair loss or color change (yellow/orange).
Dry, scaly skin with dark patches or rashes.
General health risks
Anemia (iron deficiency) and constant fatigue.
Weakened resistance to chronic or acute diseases.
In severe cases, life-threatening complications if untreated.
Early Stage
Mild, hard-to-notice symptoms: slight weight/muscle loss, reduced activity, mild appetite loss.
Immunity begins to weaken, child develops mild recurrent infections.
Moderate Stage
More noticeable: mild swelling in feet or abdomen, hair discoloration, dry/scaly skin.
Immunity significantly weakened, infections like diarrhea and respiratory illness become frequent.
Severe Stage
Clear symptoms: severe abdominal and limb swelling, major weight and muscle loss, hair loss, skin changes, extreme lethargy, almost no appetite.
Immune system critically impaired, child at high risk of fatal complications if untreated.
Chronic Stage
Occurs when protein deficiency continues untreated for long periods.
Symptoms include a combination of earlier stages with long-term complications: growth and cognitive delays, permanent immune weakness, chronic digestive issues, and persistent anemia.
Clinical examination
Direct observation of swelling, muscle loss, hair and skin changes.
Comparing the child’s weight and height to growth charts.
Nutritional assessment
Evaluating protein and calorie intake.
Asking parents about breastfeeding duration and weaning practices.
Laboratory tests
Blood tests: low albumin, anemia, iron or vitamin deficiencies.
Immune function tests: white blood cell count, antibody levels.
Excluding other causes
Ensuring malnutrition is not due to chronic illnesses (liver, kidney, or malabsorption disorders like celiac disease).
General condition and complication assessment
Checking for recurrent infections or respiratory/digestive issues.
Monitoring child’s activity and behavior to evaluate neurological effects.
Medical treatment
Antibiotics: Kwashiorkor children are often prone to bacterial infections even without clear symptoms. Antibiotics are used to prevent or treat infections in severe cases, depending on the doctor’s evaluation.
Nutritional supplements:
Vitamin A: boosts immunity, protects skin and eyes.
Zinc: reduces diarrhea severity, strengthens immunity.
Iron: treats anemia linked to kwashiorkor.
Vitamin D and calcium: support bone and dental health.
Protein or amino acid supplements: used in severe cases for rapid protein replacement.
Drugs for edema and complications:
Sometimes medications are needed to control fluid or electrolyte imbalances if severe edema occurs.
Must be used cautiously to avoid heart or kidney complications.
Important note: Medicines are not the main treatment for kwashiorkor. They only support the primary therapy, which is nutritional rehabilitation: adequate protein, balanced calories, and natural vitamins/minerals.
A. Vitamin A
Benefit: Boosts immunity, strengthens skin and eyes, and reduces the risk of infections.
How to use: Given as tablets or syrup according to the child’s age and weight, strictly under medical supervision.
B. Vitamin D
Benefit: Essential for bone and teeth health, also supports immune function.
How to use: Syrup or tablets, especially if the child does not get enough sunlight or has a deficiency.
C. Vitamin C
Benefit: Strengthens immunity, speeds wound healing, and protects the body against infections.
How to use: As syrup supplements or through vitamin C–rich foods such as oranges and strawberries.
D. B Vitamins (B1, B2, B6, B12)
Benefit: Support nervous system functions and help in the formation of red blood cells.
How to use: Usually provided in the form of multivitamin syrups for children.
E. Essential Minerals
Zinc: Strengthens immunity and reduces recurrent diarrhea.
Iron: Treats anemia often associated with kwashiorkor.
Calcium & Magnesium: Support bone and teeth health.
Important Notes
Vitamins are a supplement to dietary treatment, not a replacement.
Dosages must be carefully adjusted based on the child’s age, weight, and health condition.
Vitamins help correct nutritional deficiencies and speed up immune recovery.
Day | Breakfast | Snack | Lunch | Snack | Dinner |
---|---|---|---|---|---|
Sunday | Fortified milk + boiled egg + toast | Mashed fruit (banana or apple) | Vegetable soup with mashed chicken + rice | Fresh orange juice | Mashed potatoes with cheese + boiled vegetables |
Monday | Fruit juice + oats with milk | Cheese + biscuit | Rice with lentils + mashed vegetables | Natural yogurt with fruit | Boiled fish + mashed potatoes + carrots |
Tuesday | Milk + omelet + bread | Mashed banana or juice | Vegetable soup + mashed chicken or beef + rice | Kiwi or strawberry juice | Mashed potatoes + cottage cheese + vegetables |
Wednesday | Milk + toast + cheese | Mashed fruits | Rice with lentils + mashed vegetables + olive oil | Natural yogurt | Boiled chicken + potatoes + carrots |
Thursday | Oats with milk + mashed banana | Cheese + biscuit | Vegetable soup + boiled fish + rice | Fresh juice | Mashed potatoes + cheese + boiled vegetables |
Friday | Fortified milk + boiled egg + bread | Mashed fruits | Rice with mashed chicken + vegetables | Yogurt with fruits | Boiled fish + mashed potatoes + carrots |
Saturday | Oats with milk + fresh juice | Mashed banana or apple | Vegetable soup + mashed meat or chicken + rice | Natural yogurt | Mashed potatoes + cheese + vegetables |
Start small: Begin with small portions and increase gradually according to the child’s eating and digestive ability.
Hydration: Water, soups, and fresh juices are essential for keeping the child hydrated.
Fruits and vegetables: Offer them mashed or boiled for easier digestion and better nutrient absorption.
Avoid processed foods: They are low in protein and essential nutrients.
Regular monitoring: Track weight, height, and activity to adjust the plan to the child’s needs.
Immediate Nutritional Intervention
Gradual refeeding with easily digestible, protein-rich foods such as fortified milk or mashed meals.
Slowly increase calories to avoid digestive complications.
Provide high-quality proteins: eggs, meat, fish, legumes.
Add essential vitamins and minerals: A, D, C, iron, zinc, selenium to support immunity.
Treating Edema and Related Symptoms
Monitor swelling in the feet and abdomen.
Correct fluid and electrolyte imbalances carefully.
Regularly check blood pressure, liver, and kidney functions if needed.
Fighting Infections & Supporting Immunity
Prescribe antibiotics or antivirals when confirmed infections are present.
Keep up with vaccination schedules to prevent infectious diseases.
Maintain good personal hygiene and a clean environment to reduce exposure.
Regular Medical Follow-Up
Monitor weight, height, and overall growth regularly.
Blood tests to check protein, albumin, and vitamin levels.
Assess immune function regularly to track recovery progress.
Psychological and Family Support
Encourage the child to eat calmly and consistently.
Educate parents about the importance of a balanced, protein-rich diet.
Provide emotional support to the child to overcome lethargy and weakness caused by malnutrition.