Pediatric Protein-Calorie Malnutrition (PCM)

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.

Expanded overview

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.


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, or 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


PCM has several types, including:

  • Kwashiorkor (wet protein-energy malnutrition) – classified by a protein deficiency. It typically appears around 1 year of age when breastfeeding stops.
  • Marasmus – a total calorie/energy depletion. It typically appears between 6 months to 1 year old in children who no longer breastfeed.
  • Marasmic kwashiorkor – 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.  


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

Mild to moderate symptoms

  • 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

  • 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)
  • Mental retardation
  • Short stature
  • Skin sores
  • Thin and dry hair
  • Unable to finish average-size meals

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