Early childhood malnutrition and undernutrition
In Australia, we often associate malnutrition with our elderly population. We are fortunate here to be one of the countries in the world where malnutrition in children is not common. In fact, the level of stunting and wasting in Australia is amongst the lowest in the world. However, it is important to recognise what malnutrition in children looks like and what can be done to combat this crisis.
What is malnutrition?
Malnutrition is defined by the WHO as deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization. In general terms, malnutrition occurs overtime if someone does not meet their nutritional needs. This may be through poor intake of a variety of different foods, not eating enough food or the body has a condition where it is unable to absorb and use the nutrients it is being provided.
What does malnutrition look like in children?
Symptoms of malnutrition are extensive and diverse. We often associate weight loss with malnutrition; however, it can also affect our skin, hair and even mental health. Signs and symptoms may include:
Loss of appetite / disinterest in feeding
Weight loss (unintentional)
Fatigue and lethargy
Mental confusion or poor concentration
Symptoms in children?
Malnutrition in children can present with numerous other physical symptoms and consequences, including stunting and wasting.
Stunting: Refers to low height-for-age resulting from chronic undernutrition. Stunting prevents children from reaching their physical and cognitive potential.
Wasting: Refers to low weight-for-height. It is often a marker for recent and significant weight loss, although it can also be chronic. Wasting in children is linked with a higher risk of death.
Other childhood indicators of malnutrition may include:
Lack of energy – tiring more easily compared to other children of the same age
Failure-to-thrive (not growing or putting on weight at the expected rate)
Difficulty learning and concentrating on tasks
Kwashiorkor – leads to fluid accumulation and swelling (“pot belly”).
Undernutrition in childhood
In the western world, failure to thrive is not considered a disease or disorder, it is a complication of undernutrition. It can be caused by several environmental and physical factors, some modifiable and others not.
Causes of undernutrition in childhood include:
Poor oral intake or fussy eaters
this is more often than not associated with mealtime behaviours. It is very common for children to be stereotyped as “fussy eaters” and their selective exploration of food can become a parent’s worst nightmare at the dinner table. Fussy eating is often portrayed by inconsistencies with food choices. Sometimes children will reject familiar foods or only eat them occasionally. They might be particular with how their food is presented to them (don’t like coloured vegetables mixed up, will get upset if their food is touching on the plate etc.).
is the term used to describe a child who has very little interest in food. They might be a slow eater and their overall intake is generally inadequate.
is also common where children may consistently refuse a range of foods (e.g. doesn’t eat vegetables). In this case, generally overall food intake is adequate enough to continue to support growth and development, however this is where we might see a micronutrient deficiency.
Not providing enough nutrients
more common in infancy when breastfeeding, formula feeding or starting solids. Insufficient breast milk supply or mixing formula incorrectly can falter growth in infancy.
Food insecurity and socio-economic factors
it is no surprise that Australians are suffering at the grocery checkouts, with inflation, global pandemics, war and environmental changes impacting the cost of food, particularly fresh produce. It can be difficult for some families to provide adequate amounts of food and/or a variety of food to meet the needs of children and adolescents.
Chronic health conditions
a child who is unwell with a chronic condition (such as cancer, diabetes, cystic fibrosis) or has a disability (neurological or physical) can be at increased risk of malnutrition and faltering growth. Often, health conditions can increase the demand for nutrition and conversely, the condition, medications or therapies being received may reduce appetite and lead to nutrition impact symptoms (nausea/vomiting, diarrhoea etc.) resulting in reduced oral intake. In cases of severe undernutrition, unwell children (particularly those who may be hospitalised) may be fed through a tube.
coeliac disease, cystic fibrosis, food allergies/intolerances (e.g., lactose intolerance), pancreatitis and Chron’s disease are some of the more common malabsorption disorders affecting children. If a child has one of these conditions, the body’s ability to absorb and utilise vitamins/minerals is reduced which can result in poor weight gain and faltering growth.
Combatting malnutrition in early childhood
The main goal for treating malnutrition in children is to ensure they are able to meet their daily energy needs. Usually, the health care team will comprise of a doctor, dietitian, speech pathologist and even social worker or psychologist if required.
The role of an Accredited Practising Dietitian (APD) is of utmost importance as they are the experts in food and nutrition and can provide practical strategies with a focus on key nutrients for promoting growth and development of little bodies. An APD will often recommend a high energy diet for children who are malnourished which encourages the intake of foods and fluids rich in kilojoules.
Has your childcare centre menu been reviewed by a Dietitian?
It is recommended that childcare centres providing a menu service enlist feedback and support from Accredited Practising Dietitians (APDs). Dietitians will review or create menu that is based on the core 5 food groups, including culturally sensitive foods, lots of variety, exposure to different textures, colours and tastes and limitation of discretionary foods and fluids. This not only ensures that the menu is nutritious, but delicious, seasonal and appropriate for the children.
4 ideas to help encourage children to eat different foods to diminish undernutrition
Small frequent meals and snacks – offering 6-8 small snacks across the day instead of 3 large main meals can help with poor appetites and reduce the burden of eating a large meal.
Texture modification – may be required for picky eaters or if there is a sensory issue impacting oral intake. APDs may work with speech pathologists to overcome fussy eating issues with the aim to include more variety and acceptance of foods and food groups.
Try Food play - Food Play offers an opportunity for little ones to explore and learn about foods, without any pressure to “eat” or “try” the foods.
Serve a new food with one that the child likes - be patient and keep offering new foods, even if they are rejected at first.
For more information on malnutrition in children, menu reviews reach out to your Accredited Practising Dietitian for a personalised treatment and support plan.
Lauren Goffredo, Accredited Practising Dietitian for OSCAR Care Group