Marasmosis syndrome in children causes symptoms and treatment

Marasmus Syndrome in Children is one of the most severe forms of malnutrition that can affect young kids, especially during the first months and years of life. This syndrome occurs when a child’s body doesn’t get enough protein and calories, leading to severe weight loss, muscle weakness, and delays in physical and mental development. It is more common in communities suffering from poverty, food shortages, or chronic illnesses that affect nutrient absorption. In this article from Dalily Medical, we will explore: What is Marasmus Syndrome? What are its causes and symptoms? Which children are most at risk? And the latest methods for diagnosis and treatment that help save the child’s life and support healthy growth.

Who is Most at Risk of Marasmus Syndrome?

Marasmus can affect anyone suffering from severe malnutrition, but infants and young children are the most vulnerable since they need higher amounts of calories and protein for healthy growth. It is more common in developing countries where poverty and food scarcity are widespread, and where infections and parasites drain essential nutrients from the body. In developed countries, the highest risk is among elderly people in nursing homes or those living alone with limited resources.

What Happens to the Body in Marasmus?

When the body doesn’t get enough energy from food, it starts consuming its own tissues:

Fat stores are used first.
Muscles are broken down for energy.

To conserve energy, the body slows down vital functions:

Heart rate decreases.
Blood pressure drops.
Body temperature lowers.

In severe cases, this can lead to heart failure. The immune system is also weakened, making the child prone to frequent infections and slower recovery. Chronic marasmus can cause delays in physical and mental development, and these effects may persist even after treatment.

The digestive system is affected as well, leading to poor nutrient absorption, sometimes even after food becomes available. Interestingly, children with marasmus may lose their appetite, despite needing food urgently.

Marasmus vs. Kwashiorkor

Marasmus: Caused by lack of calories and protein → appears as extreme thinness and wasting.
Kwashiorkor: Caused mainly by protein deficiency → appears as swelling and fluid retention.

Can a Child Fully Recover from Marasmus?

Yes, especially with early treatment. Recovery depends on therapeutic nutrition, supplements, and vitamins, and the child can gradually return to normal growth.

Does Marasmus Affect Intelligence?

If untreated, it may cause cognitive delays and learning difficulties. But with early intervention and proper care, recovery chances are high.

Are There Medications for Marasmus?

There’s no specific drug for marasmus. Treatment focuses on:

Gradual nutritional rehabilitation.
Treating infections or underlying diseases.
Providing vitamins and dietary supplements.

How Can Parents Protect Their Children?

Exclusive breastfeeding for the first two years.
Provide balanced meals rich in protein, vegetables, and fruits.
Regularly monitor growth with a pediatrician.

Is Marasmus Contagious?

No, marasmus is not infectious. It is linked to malnutrition and poor living conditions.

Can Marasmus Occur in Infants?

Yes, especially with early weaning or inadequate intake of milk or complementary foods.

How Long Does Treatment Take?

Duration varies by severity, but typically weeks to months, with close monitoring of growth and health.

Does Marasmus Affect Immunity?

Yes, children with marasmus have severely weakened immunity, making them prone to recurrent infections.

Can Marasmus Cause Death?

In severe cases without treatment, it can lead to dehydration, infection, or organ failure, posing a serious risk to life.

Difference Between Marasmus and Ordinary Malnutrition

Marasmus: The most severe form of malnutrition, marked by extreme thinness and energy depletion.
Ordinary malnutrition: Usually involves minor deficiencies in specific vitamins or minerals, rarely life-threatening.

Can Marasmus Occur Even If a Child Eats?

Yes, if the diet is full of empty calories (sweets, soda) but lacks protein and essential nutrients.

Does Marasmus Affect Bones and Teeth?

Yes, affected children often have:

Weak bones (osteopenia or osteoporosis).
Delayed teething.
Poor dental growth.

Can Vaccinations Be Given to a Child with Marasmus?

Yes, but under pediatric supervision, considering the child’s immune status.

Does Marasmus Have Stages?

Yes, it progresses gradually:

Mild stage: Slight weight loss.
Moderate stage: Noticeable thinness.
Severe stage: Extreme wasting, dehydration, and serious complications.

Children Most at Risk of Marasmus

Children in poor or developing countries → limited food or protein-poor diets.
Children under 5 years old → infants and toddlers need high energy for growth.
Children weaned early → sudden transition to inadequate food.
Children with chronic illnesses → chronic diarrhea, parasites, or recurrent infections.
Orphans or neglected children → lack of proper nutrition.
Children in unsanitary conditions → exposure to contaminated water or environments increases infection and malnutrition risk.

Stages of Marasmus in Children

Early stage: Gradual weight loss, reduced appetite, pale skin, slight facial thinning.
Moderate stage: Severe thinness, protruding bones, delayed growth, weak muscles, frequent infections, dry skin, brittle hair.
Advanced (severe) stage: Extreme weight loss (<60% of normal weight), prominent ribs and bones, severe weakness, occasional swelling from protein loss, slow heart rate, low blood pressure, risk of death from infection or organ failure.

Causes of Marasmus in Children

Chronic malnutrition: Prolonged inadequate food intake, diets lacking protein and fat.
Poverty and poor living conditions: Limited food resources, unbalanced meals.
Early or improper weaning: Lack of breastfeeding, introduction of unsuitable foods.
Chronic illnesses: Digestive problems causing poor nutrient absorption, infections, or parasitic diseases.
Lack of parental awareness: Unbalanced meals, ignorance of protein and vitamin importance.
Wars, disasters, and famines: Children in these areas are at higher risk due to food and water scarcity.

Symptoms of Marasmus Syndrome in Children

Marasmus affects nearly every part of a child’s body. Key symptoms include:

Severe Weight Loss

Weight far below normal for age.
Extremely thin body with bones visible under the skin.

Muscle Wasting and Fat Loss

Almost complete loss of subcutaneous fat.
Weak, flabby muscles.

Distinct Facial Features

Pale, extremely thin face.
Face often described as “old man face.”

Dry and Loose Skin

Wrinkled, sagging skin due to fat loss.

Thin, Weak Hair

Loss of hair shine, brittle or easily falling out.

General Weakness and Fatigue

Low energy, difficulty playing or moving.

Delayed Growth and Development

Slower height and weight gain.
Delayed speech and cognitive skills.

Digestive Problems

Frequent diarrhea.
Slow digestion and poor nutrient absorption.

Weakened Immunity

Recurrent infections (respiratory, skin, or intestinal).
Slow wound healing.

Psychological and Behavioral Disorders

Irritability or depression.
Difficulty concentrating or paying attention.

Types of Marasmus in Children

Doctors categorize marasmus based on cause and severity to guide diagnosis and treatment:

Primary Marasmus (Nutritional Marasmus)

Cause: Persistent lack of protein and calories due to malnutrition.
Most affected: Children in poor families or developing countries.
Symptoms: Severe weakness, noticeable weight loss, “old man face.”

Secondary Marasmus

Cause: Chronic illnesses or health issues preventing nutrient absorption or use, such as:
- Digestive disorders (chronic diarrhea, malabsorption).
- Recurrent infections or diseases like tuberculosis.
- Endocrine disorders or tumors.
Children may consume enough food but do not benefit from it.

Mild Marasmus

Slight weight loss; some fat and muscle remain.
Faster recovery possible with early nutritional intervention.

Severe Marasmus

Most dangerous type.
Almost complete loss of fat and muscle.
Child is extremely weak, prone to infections, and may have heart and respiratory problems.

Complications of Marasmus in Children

Marasmus affects nearly all body systems and can cause serious complications if untreated:

Physical Growth Impairment

Stunted height and weight gain.
Weak muscles and bones.
Delayed teeth eruption and hair growth.

Immune System Damage

Severely weakened immunity.
Recurrent infections (lungs, intestines, skin).
Very slow wound healing.

Digestive System Issues

Chronic diarrhea or constipation.
Poor nutrient absorption.
Abdominal bloating despite low weight.

Brain and Nervous System Effects

Cognitive delays or learning difficulties.
Poor concentration and attention.
Speech and motor skill delays.

Cardiovascular Complications

Low blood pressure.
Weak or irregular heartbeats.
Risk of heart failure in severe cases.

Psychological and Behavioral Effects

Loss of activity and vitality.
Social withdrawal or poor communication.
Signs of depression or prolonged sadness.

Diagnosing Marasmus in Children

Diagnosis is based on physical examination and basic medical tests to determine severity and plan treatment:

Medical History

Ask parents about the child’s diet and whether they get enough protein and calories.
Review pregnancy and breastfeeding history, early weaning, or health problems.
Inquire about recurring symptoms like diarrhea or infections.

Physical Examination

Measure weight and height and compare with WHO growth charts.
Look for malnutrition signs:
- Severe thinness, visible bones.
- Loss of subcutaneous fat.
- Weak muscles and loose skin.
- Sharp facial features (“old man face”).

Medical Tests

Blood tests: Measure protein levels (albumin), glucose, and electrolytes.
Immune assessment: Since marasmus weakens immunity.
Stool analysis: To detect parasites or infections causing malabsorption.
Ultrasound or X-ray: Occasionally, to check internal organs.

Differentiating from Other Diseases

Essential to distinguish marasmus from other malnutrition types like kwashiorkor, as treatment may differ.

Treatment of Marasmus in Children with Medications

Medications are not the primary treatment for marasmus, but they are important for managing complications caused by severe malnutrition and help the child recover faster when combined with therapeutic nutrition.

Key medications used:

Antibiotics

Used if the child has bacterial infections or recurrent illnesses.
Common examples: Amoxicillin, Ceftriaxone (as prescribed by a pediatrician).

Vitamin and Mineral Supplements

Vitamin A: Boosts immunity and protects eyesight.
Zinc: Aids tissue repair and growth.
Iron: Treats anemia caused by malnutrition.
Folic acid: Supports the production of red blood cells.

Calcium and Magnesium Supplements

Replenish deficiencies that may cause muscle cramps or bone problems.

Anti-parasitic Medications

If the child has intestinal worms, such as Mebendazole or Albendazole.

Fluids and Electrolytes

Treat severe dehydration using oral rehydration solutions (ORS) or intravenous fluids.

✅ Important Note:

All medications must be given under the supervision of a pediatrician.
Medication treatment complements nutritional therapy and is not a replacement for it.

Treatment of Marasmus in Children with Vitamins

Vitamins are a crucial part of treatment because they:

Compensate for deficiencies caused by severe malnutrition.
Strengthen the immune system.
Support normal growth and development.

Key vitamins used:

Vitamin A

Boosts immunity and protects the eyes from malnutrition-related blindness.

Vitamin D

Helps absorb calcium and phosphorus, essential for bone and teeth growth.

Vitamin C

Powerful antioxidant, strengthens immunity, and aids wound healing.

B-Complex Vitamins (B1, B2, B6, B12)

Support energy production and the nervous system.
Help treat anemia and general weakness.

Folic Acid

Supports red blood cell production.
Essential for brain and nervous system development.

How to Manage Marasmus in Children

Marasmus is one of the most severe forms of malnutrition, and management requires a comprehensive approach including nutrition, medical care, and psychological support.

Nutritional Therapy (the foundation)

Gradual refeeding: To prevent complications.
Start with rehydration solutions if the child has lost fluids due to diarrhea.
Small, frequent meals rich in energy, such as fortified milk, rice, potatoes, and healthy fats (vegetable oils).
Add protein sources: Eggs, lentils, minced or boiled meat.
Therapeutic foods: Ready-made specialized milk formulas for malnutrition.

Medical Treatment

Replace vitamins and minerals: Vitamin A, zinc, iron, folic acid.
Treat infections or illnesses using antibiotics if needed.
Monitor blood sugar and calcium levels to avoid sudden drops.

Psychological and Social Support

Children with marasmus need special psychological care due to weakness and delayed growth.
Educate families on preparing nutritious meals simply and affordably.
Support parents emotionally, especially if malnutrition is linked to poverty or difficult circumstances.