Kwashiorkor and marasmus
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Some children with acute protein-energy malnutrition develop oedema. Oedema is an accumulation of fluid in the tissue, especially the feet and legs. Such children may not lose weight when developing acute protein-energy malnutrition because the weight of this excess oedema fluid counterbalances the weight of lost fat and muscle tissue. These children may look fat or swollen. Such children have kwashiorkor.
Kwashiorkor is very important to distinguish because the risk of death for children with kwashiorkor is higher than it is in children with just wasting or thinness.
Other children, for reasons not entirely understood, develop thinness without oedema. This condition is called marasmus.
Some children have signs of both kwashiorkor and marasmus. They have marasmic-kwashiorkor.
Both kwashiorkor and marasmus are life-threatening medical emergencies which need to be treated by sophisticated feeding programmes. Such programmes must be run by medical professionals with experience in refeeding children with severe protein-energy malnutrition.