Pediatric Protein-Calorie Malnutrition (PCM)

Protein-calorie malnutrition (PCM) (also called protein-energy malnutrition or PEM) occurs when a child doesn’t eat enough protein and energy (measured by calories) to meet nutritional needs.


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What is Pediatric Protein-Calorie Malnutrition (PCM)?

PCM most often occurs when both a child’s calorie and protein intake are inadequate. It can sometimes occur when a child only eats too little calories or only consumes too little protein, but this is rare.

PCM is a potentially life-threatening disorder.

What are the different types of Pediatric Protein-Calorie Malnutrition (PCM)?

Kwashiorkor (wet protein-energy malnutrition)

Typically appears around one year of age when breastfeeding stops


Typically appears between six months to one year old in children who no longer breastfeed

Marasmic kwashiorkor

This is the most severe form with obvious protein and calorie malnutrition. Symptoms can occur at any time. Children with this type have edema (fluid retention) and weigh below 60 percent of what is expected for their age. 

What are the signs and symptoms of Pediatric Protein-Calorie Malnutrition (PCM)?

Symptoms will vary, depending on the type, cause and age of the child. Symptoms may develop slowly, or come on rapidly.

  • Loss of 10 to 20 percent of body weight
  • Constipation
  • Difficulty chewing
  • Exhaustion
  • Loss of body fat and muscle
  • Unable to perform high-energy tasks
  • Slow heart rate
  • Weakened grip

Severe symptoms include:

  • Loss of 20 percent or more of body weight
  • Edema (fluid retention, swelling)
  • Kwashiorkor (extremely thin arms/legs, fluid collects in abdomen/other tissues and dry/peeling skin)
  • Low blood pressure (hypotension)
  • Low body temperature
  • Loose, wrinkled skin
  • Marasmus (stunted growth and wasting of muscle and tissue)
  • Short stature
  • Skin sores
  • Thin and dry hair
  • Unable to finish average-size meals

What are the causes of Pediatric Protein-Calorie Malnutrition (PCM)?

PCM occurs for several medical reasons that can be present at birth or acquired (developed). Causes include:

  • AIDS - related infections
  • Abuse or neglect
  • Burns
  • Cardiac (heart) diseases
  • Cancer
  • Diarrheainflammatory bowel disease or other gastrointestinal issues
  • Kidney diseases, such as chronic kidney failure 
  • Malnourishment for several reasons, including:
    • Reduced breastfeeding
    • Poor weaning
    • Not meeting age-specific nutritional needs (PCM commonly occurs in infants below 18 months)
  • Measles and other infectious diseases that strip the body of necessary protein/calorie balances
  • Malnourishment during pregnancy that leads to an underweight/malnourished baby