Distinguishing features of marasmus versus kwashiorkor (edematous malnutrition)

	Marasmus	Kwashiorkor (edematous malnutrition)
Height and weight	Low weight-for-height (wasting) Low height-for-age (stunting), if also chronically malnourished	Weight-for-age is variable. Low height-for-age (stunting) if also chronically malnourished.
Head	Head may appear large relative to body	May have moon face (rounded prominence of the cheeks), with or without facial edema. May appear plump.
Extremities	Emaciated arms, thighs, and buttocks, with loose folds due to loss of subcutaneous fat	Edema: Mild (1+) – Involves only the feet Moderate (2+) – Involves feet, legs, and upper limbs Severe (3+) – Either generalized edema or moderate plus facial edema
Behavior	Often irritable, fretful	Often apathetic, listless; may be irritable when handled.
Abdomen	Emaciated	Distended, dilated intestinal loops; hepatomegaly.
Skin	Thin, dry skin	Thin, dry, and peeling skin, with areas of hyperkeratosis and hyperpigmentation (dermatosis of kwashiorkor).
Hair	Thin, sparse hair that is easily plucked	Dry, dull, and hypopigmented hair that falls out or is easily plucked. Hypopigmentation may occur in stripes if malnutrition has been intermittent ("flag sign").

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