Kids Disease Child Disease Encyclopedia
Illustration representing Marasmus
Severe Macronutrient & Energy Deficiencies

Marasmus

Severe Protein-Energy Malnutrition (Non-Edematous Malnutrition)

Primary risk age: Infants under 1 year (High risk in infants who are bottle-fed with diluted formula or suffer from chronic diarrhea)

Urgency
Severe
Typical age
Infants under 1 year (High risk in infants who are bottle-fed with diluted formula or suffer from chronic diarrhea)
Body system
Nutritional & Deficiency

Typical course: Stabilization phase takes 1 to 5 days; full nutritional recovery and weight gain require 3 to 8 weeks.

Reviewed against AAP · CDC · WHO · NHS guidance Last reviewed 2026-06-13

1. Summary & Pathophysiology

Severe Protein-Energy Malnutrition (Non-Edematous Malnutrition)

Pathophysiology (Development Path)

The body adapts to severe starvation by mobilizing its own tissues for energy. Subcutaneous fat stores are depleted first, followed by catabolism of skeletal muscle protein. This leads to profound wasting, atrophy of the intestinal mucosa, and down-regulation of metabolic rate and immune function.

Primary Causes & Etiology

Severe deprivation of all dietary calories (both protein and carbohydrates) due to inadequate food supply, early weaning, or chronic malabsorption.

2. Symptom Continuum

  1. Early Onset Signs

    Persistent hunger, crying, slow weight gain or weight loss, and progressive loss of subcutaneous fat.

  2. Progressive Phase

    Extreme muscle wasting and loss of fat, giving the child an "old man" or "senile" facial appearance. The skin hangs in loose folds, especially around the buttocks and thighs ("baggy pants" sign).

  3. Severe Indicators

    Extreme emaciation (weight-for-height $<3$ standard deviations below the mean), hypothermia, bradycardia, severe dehydration, extreme listlessness, and complete apathy.

3. Clinical Verification

Clinical diagnosis based on extreme wasting of muscle and fat without edema, and a weight-for-height $<70%$ of the median. Mid-upper arm circumference (MUAC) $<11.5 ext{ cm}$ in children aged 6–59 months.

4. Care & Elements Plan

Primary Care Treatment Plan

Similar to Kwashiorkor, follow the WHO 10-step protocol for severe malnutrition. Focus on initial stabilization: correct hypothermia, hypoglycemia, dehydration (cautiously using ReSoMal to prevent heart failure), and treat infections. Progress to gradual refeeding with F-75/F-100 formulas and Ready-to-Use Therapeutic Food (RUTF).

Home Support Elements

Keep the child warm (skin-to-skin contact, warm blankets) to prevent hypothermia. Feed F-75 formula or RUTF in small, frequent amounts as directed. Monitor temperature and bowel movements.

Generic Active Ingredients (No Brands)

  • ReSoMal (specialized rehydration active fluid)
  • Potassium and Magnesium supplements
  • Amoxicillin or Ampicillin (empiric antibiotics given to all children with severe acute malnutrition due to subclinical infection risk).

Lists active elements only. Never administer self-designed therapies.

5. Doctor Critical Lines

Critical Thresholds: When to See a Doctor

Immediate emergency evaluation is required for any infant with severe wasting, loose skin folds, cold hands/feet, or extreme lethargy.

6. Vaccine & Prevention

Routine Prophylaxis (Prevention)

Encourage exclusive breastfeeding for the first 6 months of life. Ensure sanitary water supply to prevent diarrhea. Provide nutritional education and support to low-income families.

Immunization Context

Maintain immunization schedule; severely malnourished children are highly vulnerable to measles, which is frequently fatal.

7. Timelines & Outlook

Active Timeline

Stabilization phase takes 1 to 5 days; full nutritional recovery and weight gain require 3 to 8 weeks.

Expected Prognosis

Good if structured refeeding is followed. Wasted children generally tolerate refeeding better than edematous (Kwashiorkor) children, though recovery takes time.

Potential Untreated Complications

Hypothermia, hypoglycemia, heart failure (due to fluid overload during rehydration), severe infections, and high mortality.

More in Macronutrient & Energy Deficiencies

Severe

Kwashiorkor

Severe Protein-Energy Malnutrition (Edematous Malnutrition)

Infants and toddlers (Typically occurs when a child is weaned from breast milk onto a low-protein, high-carbohydrate starch diet)

Moderate

Childhood Obesity

Excess body fat that increases the risk of health problems, defined by age- and sex-specific BMI charts.

All ages; a major and growing pediatric health concern.