Identifying Malnutrition in Orphans

Malnutrition in orphans can present itself in a variety of ways. Since two or more nutrient deficiencies can occur simultaneously, symptoms can often be a result of a combination of deficiencies.

Learn more about the symptoms and risk factors associated with:

Learn more about micronutrient deficiencies in the Orphan Nutrition Library.

Iron Deficiency

In most cases, iron deficiency is asymptomatic. However, children with severe anemia may display the following symptoms:

  • Fatigue and weakness
  • Pale skin and hair loss
  • Shortness of breath
  • Headache and lightheadedness
  • Cold hands and feet
  • Inflammation or soreness of tongue
  • Brittle or spoon-shaped nails
  • Unusual cravings for non-nutritive substances such as ice, dirt, or pure starch (a condition known as “pica”)
  • Poor appetite (especially in infants and children)
  • Irritability
  • Difficulty thinking
  • Rapid heartbeat

Risk Factors

The following can put children at risk for iron deficiency or anemia:

  • Poor maternal health – especially a mother with iron deficiency anemia herself
  • Blood loss in the stools due to intestinal parasites
  • Inability to absorb iron
  • Lack of iron in the diet
  • Low birth weight
  • Bottle-feeding with formula not iron-fortified and drinking milk rather than formula in the first year
  • Tea drinking
  • Iodine Deficiency

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Iodine Deficiency

If a child has goiter caused by iodine deficiency, they may display the following symptoms:

  • Sensation of choking, especially when lying down
  • Difficulty swallowing and breathing
  • Swollen neck

If a child has hypothyroidism caused by iodine deficiency, they may display the following symptoms:

  • Feeling cold
  • Tiring easily
  • Dry skin
  • Depression
  • Forgetfulness
  • Constipation

Risk Factors

Iodine deficiency can be caused by:

  • Not enough iodine in the diet
  • Levels of iodine in soil (certain countries or regions)

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Vitamin D Deficiency

Children with Vitamin D Deficiency, or rickets, may present the following symptoms:

  • Bone pain or tenderness
  • Skeletal deformity, including bowed legs, windswept knees, boxy forehead, abnormal curvature of the spine, and/or breastbone projection in the chest
  • Dental problems, including defects in tooth structure, increased chance of cavities, poor enamel, and delayed formation of teeth
  • Increased tendency for fractures, especially greenstick fractures
  • Poor growth in height or limbs
  • Muscle spasms

Risk Factors

  • Prolonged lack of direct exposure to sunlight
  • Lack of Vitamin D and calcium in the diet

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Selenium Deficiency

Children with selenium deficiency may present the following symptoms:

  • Extreme fatigue
  • Muscle weakness or pain
  • Skin or hair discoloration
  • Mental decline

If a selenium deficiency is prolonged and severe, children may develop:

  • Weakened immune function
  • Poor heart function (Keshan Disease)
  • Hypothyroidism
  • Mental retardation (Myxedematous Endemic Cretinism)

Risk Factors

  • Low dietary intake of selenium
  • Low selenium content in the soil (certain countries or regions)

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Vitamin A Deficiency

Vitamin A deficiency can result in a condition called night blindness, where a child is unable to adapt their vision to darkness. Prolonged and severe vitamin A deficiency can lead to complete and irreversible blindness. Other symptoms of vitamin A deficiency include:

  • Dry eyes
  • Eye inflammation
  • Dry skin
  • Dry hair
  • Broken fingernails
  • Decreased resistance to infections

Risk Factors

  • Low dietary intake of vitamin A, retinol and beta carotene
  • Diet low in animal sources of pre-formed vitamin A
  • Iron deficiency
  • Vitamin B12 Deficiency

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Vitamin B12 Deficiency

Vitamin B12 deficiency can be asymptomatic, but when symptoms present they can include:

  • Fatigue and weakness
  • Diarrhea
  • Loss of appetite
  • Pallor
  • Sore mouth and tongue
  • Shortness of breath
  • Irritability and depression
  • Sleep disturbances
  • Psychosis
  • Megaloblastic anemia

Serious cases of vitamin B12 deficiency can cause damage to the nervous system, called subacute combined degeneration of the spinal cord, with the following symptoms:

  • Numbness and tingling of extremities
  • Disturbed coordination
  • Ataxic gait

Risk Factors

  • Low dietary intake of vitamin B12
  • Impaired absorption of vitamin B12
  • Intestinal parasites such as tape worm or giardiasis
  • Pernicious anemia
  • Folate Deficiency

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Folate Deficiency

Symptoms of folate deficiency include:

  • Diarrhea
  • Loss of appetite
  • Weight loss
  • Weakness
  • Sore mouth and tongue
  • Headaches
  • Heart palpitations
  • Pallor
  • Irritability
  • Behavioral disorders

Risk Factors

  • Need for folate increased (e.g. liver disease and anemia)
  • Inadequate dietary intake of folate
  • Excreting more folate than usual
  • Certain medications
  • Zinc Deficiency

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Zinc Deficiency

Because zinc plays so many roles in the body, a deficiency of zinc can impact multiple bodily functions and result in a wide variety of symptoms:

  • Dandruff, eczema, and skin rashes
  • Behavioral and sleep disturbances
  • Delayed wound healing
  • Joint pain
  • Growth retardation
  • Hair loss
  • Hyperactivity
  • Increased allergic sensitivity
  • Inflammatory bowel disease and diarrhea
  • Loss of appetite
  • Mild anemia
  • Poor nail growth, white spots on fingernails and transverse lines on fingernails
  • Hang nails

Risk Factors

  • Low intake of dietary zinc
  • Intestinal parasites
  • Intake of foods that prevent zinc absorption (e.g. foods high in iron, calcium, vitamin D and fiber)

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