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High-Yield Decision Making
Case vignette
Pediatric Malnutrition Causes, Types, Clinical Features and WHO Management
Learn complete details about pediatric malnutrition including causes, classification, marasmus and kwashiorkor differences, clinical signs, investigations, WHO stepwise treatment protocol, complications, and prevention strategies.
Case Based MCQs
Hard Clinical Vignette Quiz – 15 MCQs
Focus on warning signs, logic and differentials. Single-best-answer, NEET-PG / MD level.
❓ Frequently Asked Questions
Q: What is malnutrition in pediatrics?
A: Malnutrition in pediatrics is a condition where a child has deficiency, excess, or imbalance of energy, protein, or micronutrients, leading to poor growth, impaired immunity, and developmental delay.
Q: What are the main types of pediatric malnutrition?
A: The main types are undernutrition (wasting, stunting, underweight), protein–energy malnutrition (marasmus, kwashiorkor), micronutrient deficiencies, and overnutrition (obesity).
Q: What is the difference between marasmus and kwashiorkor?
A: Marasmus is severe calorie deficiency causing wasting without edema, while kwashiorkor is primarily protein deficiency causing edema, fatty liver, and skin/hair changes.
Q: What is severe acute malnutrition (SAM)?
A: SAM is defined by weight-for-height Z score < –3 SD, MUAC < 11.5 cm, or the presence of bilateral pitting edema.
Q: What is moderate acute malnutrition (MAM)?
A: MAM is defined by weight-for-height Z score between –2 and –3 SD or MUAC between 11.5–12.5 cm without edema.
Q: What are the common causes of malnutrition in children?
A: Common causes include inadequate dietary intake, recurrent infections (diarrhea, pneumonia), poverty, food insecurity, poor breastfeeding, malabsorption disorders, and chronic illnesses.
Q: Why are infections common in malnourished children?
A: Malnutrition weakens the immune system, making children highly susceptible to infections and reducing their ability to mount fever responses.
Q: What are the clinical signs of kwashiorkor?
A: Kwashiorkor presents with bilateral edema, moon face, flaky paint dermatosis, sparse discolored hair (flag sign), hepatomegaly, apathy, and poor appetite.
Q: What are the clinical signs of marasmus?
A: Marasmus presents with severe wasting, loss of subcutaneous fat, an old-man appearance, no edema, and usually preserved appetite.
Q: What is MUAC and why is it important?
A: MUAC (Mid-Upper Arm Circumference) is a simple screening tool for acute malnutrition; MUAC < 11.5 cm indicates severe acute malnutrition.
Q: What is the first step in managing a child with SAM?
A: The first step is to treat life-threatening conditions such as hypoglycemia, hypothermia, dehydration, and infections before starting rehabilitation feeding.
Q: Why is hypoglycemia dangerous in malnutrition?
A: Hypoglycemia can rapidly lead to seizures, coma, and death in malnourished children due to low energy reserves.
Q: What is ReSoMal used for?
A: ReSoMal is a special oral rehydration solution used for dehydrated malnourished children because it contains less sodium and more potassium than standard ORS.
Q: Why is iron supplementation delayed in SAM treatment?
A: Iron is delayed until stabilization because it can worsen infections and increase oxidative stress during the acute phase.
Q: What is F-75 formula in SAM management?
A: F-75 is a starter therapeutic milk used in the stabilization phase; it provides low protein and low sodium calories to prevent refeeding syndrome.
Q: What is F-100 or RUTF used for?
A: F-100 and Ready-to-Use Therapeutic Food (RUTF) are used in the rehabilitation phase to promote rapid catch-up growth with high-energy feeding.
Q: What is refeeding syndrome?
A: Refeeding syndrome is a metabolic complication caused by sudden aggressive feeding, leading to electrolyte shifts such as hypophosphatemia, hypokalemia, edema, and arrhythmias.
Q: What are the major complications of severe malnutrition?
A: Complications include hypoglycemia, hypothermia, severe infections, electrolyte imbalance, heart failure, developmental delay, and increased mortality.
Q: How can pediatric malnutrition be prevented?
A: Prevention includes exclusive breastfeeding for 6 months, adequate complementary feeding, immunization, micronutrient supplementation, deworming, and improving sanitation and food security.
📝 Multiple Choice Questions
Question 1: A 2-year-old child presents with severe wasting, MUAC 10.5 cm, no edema, and an alert hungry appearance. What is the most likely diagnosis?
- A. Kwashiorkor
- B. Marasmus
- C. Moderate acute malnutrition
- D. Vitamin A deficiency
✅ Correct Answer: 1
📖 Explanation: Marasmus is characterized by severe calorie deficiency leading to marked wasting without edema. MUAC <11.5 cm confirms SAM.
Question 2: A 3-year-old child has bilateral pitting edema, flaky paint dermatosis, sparse hypopigmented hair, and hepatomegaly. What is the most likely diagnosis?
- A. Marasmus
- B. Kwashiorkor
- C. Rickets
- D. Iron deficiency anemia
✅ Correct Answer: 1
📖 Explanation: Kwashiorkor results from protein deficiency and presents with edema, skin lesions, hair changes, and fatty liver.
Question 3: A severely malnourished child is admitted with blood glucose 40 mg/dL. What is the immediate management?
- A. Start iron therapy immediately
- B. Give 10% dextrose IV and start feeding
- C. Restrict oral feeds for 24 hours
- D. Start high-protein diet immediately
✅ Correct Answer: 1
📖 Explanation: Hypoglycemia is a medical emergency in SAM and requires urgent correction with IV dextrose plus early feeding.
Question 4: A child with SAM develops hypothermia (35°C) soon after admission. The best next step is?
- A. Cold sponging
- B. Keep warm and provide frequent feeds
- C. Give diuretics
- D. Start iron supplementation
✅ Correct Answer: 1
📖 Explanation: Hypothermia is common due to low metabolic reserves; warming and frequent feeding are essential.
Question 5: A malnourished child has diarrhea with dehydration. Which rehydration solution is recommended?
- A. Standard ORS in full strength
- B. ReSoMal
- C. Plain water only
- D. IV normal saline routinely
✅ Correct Answer: 1
📖 Explanation: ReSoMal is designed for malnourished children with lower sodium and higher potassium to prevent overload.
Question 6: A child with SAM is started on aggressive high-calorie feeds on day 1 and develops edema, weakness, and arrhythmias. This is known as?
- A. Refeeding syndrome
- B. Vitamin A toxicity
- C. Iron overload
- D. Celiac crisis
✅ Correct Answer: 0
📖 Explanation: Refeeding syndrome occurs due to sudden electrolyte shifts (hypophosphatemia, hypokalemia) after rapid feeding.
Question 7: The edema in kwashiorkor is mainly due to?
- A. Hypernatremia
- B. Hypoalbuminemia causing low oncotic pressure
- C. Vitamin D deficiency
- D. Excess carbohydrate intake
✅ Correct Answer: 1
📖 Explanation: Protein deficiency leads to low albumin, reducing plasma oncotic pressure and causing edema.
Question 8: A malnourished child has severe pneumonia but no fever. Why may fever be absent?
- A. No infection is present
- B. Impaired immune response due to malnutrition
- C. Vitamin overdose
- D. Excess thyroid hormone
✅ Correct Answer: 1
📖 Explanation: Severe malnutrition suppresses immune function, so fever response may be absent despite infection.
Question 9: A child with SAM is started on F-75 formula. What is the primary purpose of F-75?
- A. Rapid weight gain
- B. Stabilization with low protein and sodium
- C. Correction of iron deficiency
- D. High-fat feeding for catch-up growth
✅ Correct Answer: 1
📖 Explanation: F-75 is used during stabilization phase to avoid metabolic overload and prevent refeeding syndrome.
Question 10: A stabilized malnourished child now requires catch-up growth. Best nutritional therapy is?
- A. Continue F-75
- B. Switch to F-100 or RUTF
- C. Only breast milk
- D. Glucose water
✅ Correct Answer: 1
📖 Explanation: F-100 or RUTF provides high energy and protein for rehabilitation and rapid weight gain.
Question 11: Iron supplementation is delayed in SAM because?
- A. Iron causes obesity
- B. Iron may worsen infections during acute stabilization
- C. Iron is not required in children
- D. Iron causes hypoglycemia
✅ Correct Answer: 1
📖 Explanation: Iron is delayed until stabilization since it can enhance bacterial growth and oxidative stress in acute illness.
Question 12: A child has MUAC 11.3 cm without edema. Classification is?
- A. Normal nutrition
- B. Moderate acute malnutrition
- C. Severe acute malnutrition
- D. Overnutrition
✅ Correct Answer: 2
📖 Explanation: MUAC <11.5 cm defines severe acute malnutrition even without edema.
Question 13: A child with chronic malnutrition has height-for-age below -3 SD. This indicates?
- A. Wasting
- B. Stunting
- C. Obesity
- D. Pure micronutrient deficiency
✅ Correct Answer: 1
📖 Explanation: Stunting reflects chronic undernutrition with long-term growth failure.
Question 14: WHO-recommended empirical antibiotics for children with SAM include?
- A. Ampicillin + Gentamicin
- B. Azithromycin only
- C. No antibiotics unless culture positive
- D. Metronidazole only
✅ Correct Answer: 0
📖 Explanation: SAM children have high risk of occult infections; WHO recommends broad-spectrum antibiotics empirically.
Question 15: WHO-recommended empirical antibiotics for children with SAM include?
- A. Ampicillin + Gentamicin
- B. Azithromycin only
- C. No antibiotics unless culture positive
- D. Metronidazole only
✅ Correct Answer: 0
📖 Explanation: SAM children have high risk of occult infections; WHO recommends broad-spectrum antibiotics empirically.