Explain the Marasmus - protein energy malnutrition?

Marasmus, the other end of the same spectrum as kwashiorkor, is common in children below the age of 2 years. The characteristic manifestations are:

• Severe growth retardation
• Extreme emaciation
• Old man's or monkey's face, and
• Loose and hanging skin folds over arms and buttocks.

Box lists the signs and symptoms of marasmus.

A typical case of marasmus can be described as a bonny cage having nothing but "skin and bones". You would notice that the marasmic children are so weak that they may not have even energy to cry, which most often is barely audible. The child is extremely wasted with very little subcutaneous fat with the skin hanging loosely particularly over the buttocks. In Fact, when you hold the marasmic child in a standing position, you can see the loose skin folds hanging prominently, unlike in any normal child. For the given age, the children will be generally below 60% normal or < Median - 3SD of the standards. We will learn about these standards later in these units. Unlike in kwashiorkor, oedema is absent and there are no skin and hair changes. However, frequent diarrhoea1 episodes leading to dehydration and micronutrient deficiencies of vitamin A, iron and B-complex are common.