Article # 142 . What Is Kwashiorkor?

What Is Kwashiorkor?

Kwashiorkor is a disease caused by the lack of protein in a child's diet. Kwashiorkor is a type of protein energy malnutrition (PEM) that is widespread throughout the developing world. Infants and children growing up in tropical or subtropical areas (such as Africa, Asia, and South America) where there is much poverty are at risk for kwashiorkor.

The term "kwashiorkor" comes from a word used in Ghana that means a "disease of a baby deposed from the breast when the next one is born." Kwashiorkor usually happens when a baby is weaned from protein-rich breast milk (for any reason) and switched to protein-poor foods. In impoverished countries, protein-rich foods are difficult to acquire.

Kwashiorkor is most common in areas where there is:

·         Famine

·         Limited food supply

·         Low levels of education (when people do not understand how to eat a proper diet)

This disease is more common in very poor countries. It often occurs during a drought or other natural disaster, or during political unrest. These conditions are responsible for a lack of food, which leads to malnutrition.

"Many children in this West African village show signs of kwashiorkor. Their stomachs are bloated, their arms and legs are thin, and their skin is flaky"

What Are the Symptoms of Kwashiorkor?

Children with kwashiorkor have edema (excess water retention in body tissues), which makes them look puffy and bloated. They are weak and irritable, and in many cases their skin flakes, and their hair loses its curliness and color. If left untreated, kwashiorkor causes enlargement of the liver, loss of fluids (dehydration) from the bloodstream even when the child has edema, stunted growth, and severe infection due to a weakened immune system. It also can result in jaundice, drowsiness, and a lowered body temperature.

·         Changes in skin pigment

·         Decreased muscle mass

·         Diarrhea

·         Failure to gain weight and grow

·         Fatigue

·         Hair changes (change in color or texture)

·         Increased and more severe infections due to damaged immune system

·         Irritability

·         Large belly that sticks out (protrudes)

·         Lethargy or apathy

·         Loss of muscle mass

·         Rash (dermatitis)

·         Shock (late stage)

·         Swelling (edema)

Treatment

Getting more calories and protein will correct kwashiorkor, if treatment is started early enough. However, children who have had this condition will never reach their full potential for height and growth.
Treatment depends on the severity of the condition. People who are in shock need immediate treatment to restore blood volume and maintain blood pressure.

Calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are started after other sources of calories have already provided energy. Vitamin and mineral supplements are essential.
Since the person will have been without much food for a long period of time, eating can cause problems, especially if the calories are too high at first. Food must be reintroduced slowly. Carbohydrates are given first to supply energy, followed by protein foods.

Many malnourished children will develop intolerance to milk sugar (lactose intolerance). They will need to be given supplements with the enzyme lactase so that they can tolerate milk products.

Expectations (prognosis)

Getting treatment early generally leads to good results. Treating kwashiorkor in its late stages will improve the child's general health. However, the child may be left with permanent physical and mental problems. If treatment is not given or comes too late, this condition is life-threatening.

Complications

·         Coma

·         Permanent mental and physical disability

·         Shock

Calling your health care provider

Call your health care provider if your child has symptoms of kwashiorkor.

Prevention

To prevent kwashiorkor, make sure the diet has enough carbohydrates, fat (at least 10 percent of total calories), and protein (12 percent of total calories).

Reference: Heird WC. Food insecurity, hunger, and undernutrition.