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. 

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

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)

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

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)

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

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

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

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)