Children<br><br>


Clinical signs of malnutrition</span></h3>
<table class="wikitable">
<tr>
<th>Site</th>
<th>Sign</th>
</tr>
<tr>
<td>Face</td>
<td>Moon face (kwashiorkor, simian facies (marasmus)</td>
</tr>
<tr>
<td>Eye</td>
<td>Dry eyes, pale conjunctiva, Bitot's spots (vitamin A), periorbital edema</td>
</tr>
<tr>
<td>Mouth</td>
<td>Angular stomatitis, cheilitis, glossitis, spongy bleedng gums (vitamin C), parotid enlargement</td>
</tr>
<tr>
<td>Teeth</td>
<td>Enamel mottling, delayed eruption</td>
</tr>
<tr>
<td>Hair</td>
<td>Dull, sparse, brittle hair, hypopigmentation, flag sign (alternating bands of light and normal color), broomstick eyelashes, alopecia</td>
</tr>
<tr>
<td>Skin</td>
<td>Loose and wrinkled (marasmus), shiny and edematous (kwashiorkor), dry, follicular hyperkeratosis, patchy hyper- and hypopigmentation, erosions, poor wound healing</td>
</tr>
<tr>
<td>Nail</td>
<td>Koilonychia, thin and soft nail plates, fissures or ridges</td>
</tr>
<tr>
<td>Musculature</td>
<td>Muscles wasting, particularly in the buttocks and thighs</td>
</tr>
<tr>
<td>Skeletal</td>
<td>Deformities usually a result of calcium, vitamin D, or vitamin C deficiencies</td>
</tr>
<tr>
<td>Abdomen</td>
<td>Distended - hepatomegaly with fatty liver, ascites may be present</td>
</tr>
<tr>
<td>Cardiovascular</td>
<td>Bradycardia, hypotension, reduced cardiac output, small vessel vasculopathy</td>
</tr>
<tr>
<td>Neurologic</td>
<td>Global development delay, loss of knee and ankle reflexes, impaired memory</td>
</tr>
<tr>
<td>Hematological</td>
<td>Pallor, petechiae, bleeding diathesis</td>
</tr>
<tr>
<td>Behavior</td>
<td>Lethargic, apathetic</td>
</tr>
</table>
<table class="wikitable" border="1">
<tr>
<th>Degree of PEM</th>
<th>Stunting (%) Height for age</th>
<th>Wasting (%) Weight for height</th>
</tr>
<tr>
<td>Normal: Grade 0</td>
<td>&gt;95%</td>
<td>&gt;90%</td>
</tr>
<tr>
<td>Mild: Grade I</td>
<td>87.5-95%</td>
<td>80-90%</td>
</tr>
<tr>
<td>Moderate: Grade II</td>
<td>80-87.5%</td>
<td>70-80%</td>
</tr>
<tr>
<td>Severe: Grade III</td>
<td>&lt;80%</td>
<td>&lt;70%</td>
</tr>
<tr>
<th colspan="16"><small>SOURCE: "Classification and definition of protein-calorie malnutrition