Hana Al-Rai (3 years old) receives treatment for malnutrition at the Al-Aqsa Martyr Hospital in Gaza. Here, she gets help from her sister to measure her blood sugar.

What happens to young children who become malnourished?

If a child becomes acutely malnourished during the first thousand days of their life, they can fully recover. But only if the child receives proper treatment, according to a professor.

More than 8,000 children under the age of five in the Gaza Strip have been treated for acute malnutrition since the war broke out, according to the World Health Organization (WHO).

“Despite reports of increased delivery of food, there is currently no evidence that those who need it most are receiving sufficient quantity and quality of food," WHO Director-General, Tedros Adhanom Ghebreyesus, said in a press release.

Gaza is not the only place on the planet where children are starving. Worldwide, 45 million children under the age of five were acutely malnourished in 2021, according to Save the Children.

What happens to the small bodies when they become malnourished? Is it possible to recover, or do these children suffer lifelong damage after being acutely malnourished?

Thorkild Tylleskär is a paediatrician and professor of international health at the University of Bergen.

He explains that malnourished children stop moving and neither cry, smile, nor laugh. They also stop eating, even when they finally get food.

“They do absolutely nothing,” says Tylleskär.

The body's functions stop

The body changes when it is malnourished.

The digestive system, immune system, and movement are affected first, according to Tylleskär.

Children who are acutely malnourished can develop something reminiscent of AIDS, namely NAIDS.

“This is a kind of nutrition-induced AIDS,” says Tylleskär.

These children develop the same type of challenging infections as AIDS patients because the body is unable to produce immune cells.

“The difference is that NAIDS can be cured,” he says.

Tylleskär explains that some children become so thin that their muscles disappear, and knees and elbows stick out. Some develop oedema when they are malnourished, where the whole body swells up, and they develop what is called moon face. Their faces becomes swollen and round, with a bluish-red complexion, according to WebMD.

An infection without symptoms

Similar to people with AIDS, malnourished children struggle to cope with infections. The body's response to infection is inflammation.

Usually, four things happen when something is inflamed: It becomes red, warm, painful, and swollen. 

But when a child is severely malnourished, none of this happens.

“They can get a wound on their cheek that looks perfectly fine, but in reality, it's fully inflamed. The body just doesn't react to it – it doesn't tell you through symptoms,” he says.

The infection is thus allowed to spread freely in the body, and eventually, the child becomes very ill.

The intestinal surface shrinks

A number of things also happen inside the body when it is not fed.

Normally, the body uses a lot of its energy to replenish cells, including those in the intestines. When the body goes into energy-saving mode, this process is greatly reduced.

As a result, the intestinal villi are worn down, and the surface of the intestine becomes smaller.

“When you then start eating food again, the intestines can't absorb the food because the intestinal villi have become completely flat. The food can't be digested, and the child gets diarrhoea,” Tylleskär says.

The blood also contains lot of sodium and little potassium, while it’s the opposite in the cells – meaning they contain a lot of potassium and little sodium. That's how it should be.

But when there is not enough energy to maintain this balance, potassium leaks from the cells into the blood.

High potassium is very dangerous and can even stop the heart.

Treating acute malnutrition

Tylleskär has himself treated children suffering from malnutrition in low-income countries. He knows it is possible to treat it.

Because effective treatment is available.

If the child is over six months old, they receive supplements that they either manage to eat themselves or get through a tube from the nose to the stomach. The child then receives small doses of food very frequently.

The supplement has the same content as breast milk and contains all the trace elements and minerals that children need.

The child receives this in the first week.

A week before the children smile again

“Slowly, you begin to reverse the energy deficiency so that the systems start functioning again,” says Tylleskär.

Then the digestive system and immune system start working again.

“It takes about a week before the child smiles for the first time,” he says.

Gradually, the child receives more appropriate supplements and can start to eat proper food.

There are various forms of supplements, including packages of RUTF, which is an acronym for ready-to-use therapeutic food. This is a mixture of peanut butter, milk powder, oil, powdered sugar, and trace elements.

Thorkild Tylleskär is a professor at the University of Bergen's Department of Global Public Health and Primary Care.

Will these children be permanently affected?

A study from 2016 shows that acute malnutrition has several long-term consequences for children.

Seven years after treatment, children who had been malnourished were significantly shorter than children who had not been. They also had shorter leg length, thinner upper arms, thinner calves, and narrower hips, and they weighed less than the other children.

Physical tests also showed that they had reduced grip strength.

Tylleskär explains that if a child becomes acutely malnourished during the first thousand days of their life, which includes nine months in the womb and two years out in the world, they can, in principle, fully recover.

“If the condition is properly handled, of course,” he says.

Lack of movement has consequences

Tylleskär nevertheless says that all bad things that happen to children inevitably reduce the child's potential.

“It's much better for the child to eat and feel well all the time. If they don’t get that, there's a cost. Perhaps not when it comes to each individual child, but in a large group this will be evident,” he says.

He also believes a lack of movement can have consequences as an adult.

“If you sit for two months and do nothing, then you will not become a world-class football player afterwards. You can certainly have an okay life, but your potential is reduced,” he says.

Food shortage is an excellent weapon

Tylleskär believes that what is happening in Gaza now is a kind of abuse of children. Large-scale child abuse.

“Gaza has been called the world's largest outdoor prison, and now they are bombing the prison. It’s tragic that we are not able to do a better job of putting an end to this,” he says.

It’s almost impossible for people not to react to the horrific images of children suffering in Gaza. Tylleskär believes these images can help motivate people to give money to organisations that distribute food, such as UNICEF, which provides emergency packages of peanut butter, milk powder, and powdered sugar.

“But it only helps if the food gets through,” he says.

“Taking food away from people is an effective weapon. Stalin used it in Ukraine a hundred years ago, it was used in Ethiopia in the 1980s, and we see it in Sudan today. Food is an excellent weapon, and it's very cheap to withhold food.” 


Translated by Nancy Bazilchuk

Read the Norwegian version of this article on forskning.no

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