What is Kwashiorkor?
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What Is Kwashiorkor?
Kwashiorkor is a type of protein-energy undernutrition marked by severe swelling and a bloated stomach. [1] It mainly affects children in developing countries who are rapidly weaned onto a high-carbohydrate, low-protein diet. [1] Unlike marasmus, children may look swollen rather than wasted. [1] Without prompt medical treatment, it can cause permanent growth and developmental delays or death. [1]
What the research says
Kwashiorkor is metabolically different from marasmus, and recovery may continue beyond hospital discharge. In a study of 40 hospitalized Malawian children with severe acute malnutrition (21 with kwashiorkor, 19 with marasmus) and 157 community controls, 91% of the measured metabolites (128 of 141) were lower in children with kwashiorkor than in those with marasmus at admission. Metabolic profiles stayed very different from those of community children even after clinical stabilization, suggesting that recovery extends beyond discharge (Di Giovanni et al., Journal of Nutrition, 2016 [2]).
Preventing deaths in hospitalized children with severe malnutrition remains difficult. In a randomized trial of 1,778 Kenyan children with complicated severe acute malnutrition (17% with kwashiorkor), daily co-trimoxazole prophylaxis did not reduce mortality (14% versus 15% with placebo; hazard ratio 0.90, 95% CI 0.71-1.16) (Berkley et al., Lancet Global Health, 2016 [3]).
Hospital mortality stays high even where community treatment has expanded. A national analysis in Malawi from 2011 to 2019 found that outpatient therapeutic feeding admissions rose from 30,323 to 37,655 children and the share of children with edema fell, but mortality in inpatient nutritional rehabilitation units did not change and was 11.0% in 2019 (Daniel et al., Malawi Medical Journal, 2024 [4]).
Key Takeaways: Kwashiorkor Facts
Feature | Details |
Medical Name | Kwashiorkor |
Primary Cause | Severe protein deficiency [1] |
Most Affected | Children aged 3–5 in food-insecure regions [1] |
Defining Symptom | |
Difference from Marasmus | Kwashiorkor is mainly a protein deficiency with edema; marasmus is a deficiency of all macronutrients [1] |
Diagnosis | Physical exam and growth chart assessment [1] |
Treatment | WHO 10-step protocol for severe undernutrition [1] |
Prognosis | Better with early treatment; some children have lasting growth and development effects [1] |
What exactly is kwashiorkor?
Kwashiorkor is one of the two main types of severe protein-energy undernutrition. [1] The term originates from the Ga language of Ghana, translating to "the sickness the baby gets when the new baby comes." [1] This name reflects a common scenario in many developing nations: a nursing toddler is abruptly weaned when a new sibling is born. [1] If the replacement diet consists primarily of starchy, low-protein staples like rice or corn, the child's health can rapidly deteriorate. [1]
Unlike marasmus, where the body wastes away due to a lack of all macronutrients, kwashiorkor is predominantly a protein deficiency. [1] Protein is essential for maintaining the balance of fluids in the blood vessels. [5] When protein levels drop too low, fluid leaks into the surrounding tissues, causing the characteristic swelling known as edema. [1]
What are the symptoms and complications of kwashiorkor?
Kwashiorkor causes swelling of the face, hands, feet and belly despite thin limbs, along with skin and hair changes, muscle wasting, poor appetite and irritability. [1]
Recognizing the Signs
The physical appearance of kwashiorkor can be deceptive. While the child's limbs may look thin and wasted, their face, hands, feet, and abdomen often appear swollen. [1]
Edema: Fluid retention that causes the skin to look puffy and tight, especially in the ankles and feet. [1]
Distended Abdomen: A large, bloated belly caused by fluid in the abdominal cavity (ascites) and an enlarged fatty liver. [1]
Skin and Hair Changes: Skin may become dry, scaly, or red, and hair often becomes brittle and loses its natural pigment. [1]
Muscle Wasting: Significant loss of muscle mass, even if some body fat remains. [1]
Loss of Appetite and Irritability: Children are often fatigued, irritable, and unwilling to eat. [1]
Stunted Growth: Children with kwashiorkor are typically shorter and smaller than their peers. [1]
Potential Complications
If left untreated, kwashiorkor affects every system in the body, leading to life-threatening issues.
Complication | Impact on the Body |
Hypoglycemia | Critically low blood sugar levels. [1] |
Hypothermia | Inability to maintain a safe body temperature. [1] |
Dehydration and Electrolyte Imbalance | Low blood volume and imbalances that can lead to shock. [1] |
Immune Failure | Frequent infections and an inability to heal wounds. [1] |
Organ Damage | Liver failure, cirrhosis, and atrophy of the pancreas. [1] |
Developmental Delays | Permanent loss of intellectual and physical potential in some children. [1] |
What causes kwashiorkor, and who is at risk?
Kwashiorkor is caused by an imbalanced diet, with poverty and food insecurity as the underlying drivers. [1] Many researchers believe protein deficiency is the cause, but not all are convinced: in some cases, dietary protein alone did not prevent or improve kwashiorkor, suggesting protein deficiency may be only part of the picture. [1]
High-Carb Staples: In many rural areas, the only affordable foods are starchy vegetables, corn, or rice. These provide calories but very little protein. [1]
Inadequate Weaning: Transitioning a child from protein-rich breast milk to a low-protein diet too quickly is a major trigger. [1]
Environmental Stress: Famine, war, and natural disasters can disrupt food supplies and increase the risk of malnutrition. [1]
Secondary Factors: Parasites, infections like measles, malaria, or HIV, and toxins from mold (aflatoxins) on stored crops can worsen the condition. [1]
How is kwashiorkor diagnosed and clinically assessed?
Healthcare providers diagnose kwashiorkor primarily through a physical examination. They look for the telltale signs of edema and a bloated stomach while taking a detailed history of the child's diet and illnesses. [1]
Growth Charts: Doctors measure the child's weight and height, comparing them to standard growth charts to determine the severity of stunting and wasting. [1]
Physical Indicators: Checking for skin peeling, hair discoloration, and an enlarged liver.
Dietary Review: Assessing the protein content of the child's daily food intake.
How is kwashiorkor treated, and how do children recover?
Treating kwashiorkor is a delicate process. Because the body's metabolism has slowed down to survive, introducing food too quickly can cause a dangerous reaction known as "refeeding syndrome." [1]
The WHO 10-Step Protocol
The World Health Organization (WHO) has outlined 10 steps for treating severe undernutrition: [1]
Treat or prevent hypoglycemia: Low blood sugar can occur when calories are introduced, so glucose is given in the first hours of treatment. [1]
Treat or prevent hypothermia: Malnourished bodies have trouble regulating their temperature, so they must be kept warm. [1]
Treat or prevent dehydration: A special formula called RESOMAL (REhydration SOlution for MALnutrition) restores and maintains fluid and sodium balance. [1]
Correct electrolyte imbalances: These can be life-threatening, especially when refeeding begins. [1]
Treat or prevent infection: With a weakened immune system, all infections are serious threats and are treated with antibiotics. [1]
Correct micronutrient deficiencies: Vitamin and mineral deficiencies are corrected before refeeding. [1]
Start cautious feeding: Feeding begins slowly under close observation, and protein in particular is reintroduced gradually. [1]
Achieve catch-up growth: Once the child is stable, calories are increased to promote rapid weight gain. This stage may last up to six weeks. [1]
Provide sensory stimulation and emotional support: Stimulation helps the child's brain and social skills recover, ideally with the mother involved. [1]
Prepare for follow-up after recovery: Families receive nutrition counseling, and immunizations are provided as needed. [1]
How can kwashiorkor be prevented?
Preventing kwashiorkor requires a combination of nutritional education and improved food security.
Balanced Diet: Ensuring access to protein-rich foods such as beans, lentils, eggs, meat, and dairy.
Proper Weaning: Educating parents on how to gradually transition children to a healthy, balanced diet.
Public Health: Improving sanitation and immunizations to reduce the burden of parasites and infections that contribute to malnutrition. [1]
Conclusion
Kwashiorkor is a devastating but preventable condition. While it remains a significant challenge in areas of extreme poverty, early medical intervention and nutritional support lead to the best outcomes. By focusing on balanced nutrition and proper child care practices, we can help protect the most vulnerable populations from the long-term effects of protein deficiency.
For more helpful health resources and visual guides, explore our infographic templates.
Frequently Asked Questions
Can kwashiorkor be cured?
Yes, it is highly treatable if medical care is sought early and the proper refeeding protocols are followed. [1]
Is kwashiorkor the same as starvation?
It is a form of severe undernutrition, specifically a lack of protein. A person can get enough calories to survive but still develop kwashiorkor. [1]
Why does the stomach swell?
The swelling is caused by fluid leaking from the blood vessels into the abdomen because there isn't enough protein to keep it in. [5]
Can adults get kwashiorkor?
While rare, adults can develop it during extreme famine or if they have severe malabsorption issues.
What is the difference between kwashiorkor and marasmus?
Kwashiorkor is predominantly a protein deficiency with swelling; marasmus is a deficiency of all macronutrients, where the person looks extremely thin. [1]
Is kwashiorkor contagious?
No, it is a nutritional deficiency and cannot be spread from person to person.
What foods prevent kwashiorkor?
Foods high in protein like beans, nuts, seeds, eggs, meat, and milk are essential for prevention.
How long does treatment take?
The initial stabilization steps take days, and the catch-up growth stage of nutritional rehabilitation may last up to six weeks. [1] Follow-up care continues after the child goes home.
Can a child recover fully?
Most children can recover, but if the malnutrition was severe and lasted a long time, there may be permanent growth stunting.
What is "refeeding syndrome"?
It is a dangerous metabolic reaction that occurs when a severely malnourished person is given food too quickly. [1]
Why does hair change color in kwashiorkor?
A lack of protein affects the body's ability to produce melanin, the pigment that gives hair its color.
What is an "enlarged fatty liver"?
Without protein to transport fats out of the liver, the organ becomes clogged with fat and swells.
Can breastfeeding prevent kwashiorkor?
Yes, breast milk is an excellent source of protein for infants. The problem usually begins after the child is weaned.
Is kwashiorkor common in the United States?
No, it is extremely rare in developed countries [1] and is usually only seen in cases of severe child neglect or unusual diets.
What is RESOMAL?
It stands for REhydration SOlution for MALnutrition, a special drink designed to restore fluids and electrolytes safely. [1]
Does kwashiorkor affect the brain?
Yes, severe protein deficiency can stunt intellectual and neurological development in young children.
Can parasites cause kwashiorkor?
Parasites don't cause it directly, but they can steal nutrients from the child, making a protein deficiency much worse.
What are aflatoxins?
They are toxins produced by molds that grow on crops like corn and peanuts in hot, humid climates. [1]
Why are children aged 3-5 most at risk? [1]
This is the typical age when children are weaned from breast milk and may not receive enough protein in their new diet.
How is kwashiorkor diagnosed?
It is primarily diagnosed through a physical exam, looking for edema and checking growth measurements. [1]
Can kwashiorkor be fatal?
Yes, without treatment, it can lead to death from infection, dehydration, or liver failure. [1]
What is "pitting edema"?
It is a type of swelling where pressing a finger into the skin leaves a temporary indentation or "pit."
Does kwashiorkor cause pain?
The swelling and skin peeling can be very uncomfortable, and children are often irritable and lethargic.
Can vaccines help?
While they don't prevent malnutrition, vaccines for diseases like measles can prevent the infections that often contribute to kwashiorkor.
What is the Ga language?
It is a language spoken in Ghana, where the term "kwashiorkor" comes from.
Is protein powder a good treatment?
In a clinical setting, specialized therapeutic formulas are used, and protein must be reintroduced very gradually. Giving protein on its own at home may be insufficient and even dangerous.
Can kwashiorkor cause anemia?
Yes, a lack of protein and iron often leads to severe anemia in malnourished children.
What is "wasting"?
Wasting is when a child is too thin for their height, indicating recent and severe weight loss.
What is "stunting"?
Stunting is when a child is too short for their age, indicating chronic, long-term malnutrition.
Can solving poverty stop kwashiorkor?
Improving economic conditions and food security is the long-term solution to eradicating kwashiorkor.
What is the "stabilization phase"?
It is the first few days of treatment focused on keeping the patient alive and treating acute complications.
Can kwashiorkor affect the heart?
Severe malnutrition can weaken the heart muscle, which is one reason fluids and feeding must be managed carefully. [5]
Why is infection so dangerous?
Malnourished children have a weakened immune system, [1] so even a minor illness can turn into a serious infection.
What is the role of the pancreas in kwashiorkor?
The pancreas can shrink (atrophy), making it hard for the body to produce the enzymes needed to digest food. [1]
Can kwashiorkor be prevented with beans?
Beans and lentils are affordable, high-protein alternatives in regions where meat is scarce and can be part of a balanced diet that helps prevent it.
Does kwashiorkor cause skin peeling?
Yes, dermatitis is common, where the skin becomes dry and peels off in patches. [1]
Can vitamin A help?
Vitamin A and other micronutrients are commonly given as part of treatment to correct deficiencies and support the eyes and immune system.
What is a "distended abdomen"?
It is a medical term for a stomach that is swollen outward beyond its normal size.
Is kwashiorkor a public health emergency?
In many parts of the world, high rates of severe malnutrition, including kwashiorkor, are considered a major public health crisis.
Can kwashiorkor cause hair loss?
Yes, hair becomes dry and brittle, and can fall out. [1]
What is "subcutaneous fat"?
It is the layer of fat directly under the skin, which may still be present in kwashiorkor patients. [1]
How does famine contribute to kwashiorkor?
Famine eliminates access to many foods, but protein sources are usually the first to disappear or become unaffordable.
Can kwashiorkor affect other organs?
Severe malnutrition can affect many organ systems, and fluid and electrolyte imbalances are a major concern during treatment.
What is "catch-up growth"?
It is the period in recovery where a child gains weight and height rapidly to reach their normal growth path.
Is the "bloated belly" actually fat?
No, it is a combination of fluid (ascites) and an enlarged, fatty liver. [1]
Can kwashiorkor be diagnosed with a blood test?
While not required for diagnosis, blood tests can show very low levels of albumin (a blood protein). [5]
Can education prevent kwashiorkor?
Yes, teaching mothers about nutrition and proper weaning can save lives even in poor communities.
Should I see a doctor if my child's stomach is swollen?
Yes, a swollen stomach in a child who is not gaining weight is a serious medical sign that requires immediate attention.
Related Reading
References
Cleveland Clinic. Kwashiorkor: Definition, Symptoms, Causes & Diagnosis. Cleveland Clinic. Last updated May 18, 2022. https://my.clevelandclinic.org/health/diseases/23099-kwashiorkor
Di Giovanni V, Bourdon C, Wang DX, et al. Metabolomic changes in serum of children with different clinical diagnoses of malnutrition. J Nutr. 2016;146(12):2436-2444. PMID 27807038. https://doi.org/10.3945/jn.116.239145
Berkley JA, Ngari M, Thitiri J, et al. Daily co-trimoxazole prophylaxis to prevent mortality in children with complicated severe acute malnutrition: a multicentre, double-blind, randomised placebo-controlled trial. Lancet Glob Health. 2016;4(7):e464-e473. PMID 27265353. https://doi.org/10.1016/S2214-109X(16)30096-1
Daniel AI, Kathumba S, Mitambo C, et al. Trends in severe acute malnutrition admissions, characteristics, and treatment outcomes in Malawi from 2011 through 2019. Malawi Med J. 2024;36(2):73-79. PMID 40191564. https://doi.org/10.4314/mmj.v36i2.3
Benjamin O, Lappin SL. Kwashiorkor. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. PMID 29939653. https://www.ncbi.nlm.nih.gov/books/NBK507876/
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always seek the counsel of a qualified healthcare professional regarding any medical condition or emergency. If you are experiencing a life-threatening emergency, call 911 or your local emergency services immediately.
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