We use the term ‘protein energy malnutrition’ (PEM) to cover a spectrum of clinical pictures arising from the lack of nutrients in the child’s diet, principally protein and calories. It occurs most frequently in infants and children and is often associated with infections.

Symptoms:

• There is history of weight loss.
• The child is thin, tired and usually dehydrated,
• His growth is stunted.
• He has dry and flaky skin, reduced hair growth.

• The capacity of the heart to pump blood is reduced by 30% in the malnourished. The blood pressure is lowered.
• The typical child with PEM has a moderate anemia with a hemoglobin concentration of about 8–10 g/dl. The principal cause of anemia is generally less iron in the diet and/or loss of blood due to malaria and intestinal parasites. Anemia lowers resistance to disease and weakens a child’s learning ability and physical stamina.
• Protein deficiency limits blood production, so that iron though available cannot be used. Also, there is a decreased life span of red blood cells.
• The liver is enlarged due to the lack of protein.
• The inner lining of the gastrointestinal tract is affected, thereby the absorption of the nutrients in the diet is reduced.
• There is a reduction in kidney weight and ability to concentrate urine is impaired. The damage to the kidneys due to malnutrition is irreversible.
• The head circumference is less than in normal children of same age, brain weight is reduced in severely malnourished children. This deficit in weight of the brain is accompanied by a deficit in total number of brain cells.
• Skin lesions are observed. These begin with reddish spots which become black, hard, scaly and raised. Cracking of the skin surface follows fusion of these spots. Often there is ulceration on the body creases and on exposed surfaces. The skin and hair become lighter in color. Hair becomes thin and can be easily pulled out.

Thus, the major organs of the body are affected if the infant is not fed an optimum diet. If the growth and development of the organs is impaired in the first two years, the damage can never be reversed. Malnutrition impairs the mental and cognitive development of the child, and can lower IQ by upto 9 points.

Hence, adequate intake of protein, energy, micronutrients during the growing years of the child i.e. infancy is closely related to the survival, physical and mental development, good health and the overall wellbeing of the child as an adult.

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