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The most obvious effect of malnutrition is on growth. The severity, timing, and duration of caloric deprivation determine the degree of growth inhibition. In growing children, height best reflects overall nutritional condition: body weight and amount of subcutaneous fat depend on recent intake rather than on the duration of undernutrition. In severe cases of malnutrition, growth ceases. In less extreme conditions, growth velocity is reduced. Young infants are more vulnerable to the effects of malnutrition on growth than older children. Children with chronic caloric undernutrition are short, have retarded bone ages, and normal dental ages. Although weight is below normal for age, weight for height is often normal (due to the reduction in height).

Like height and weight, head circumference may be reduced by malnutrition. Although height tends to catch up with time, head circumference in children who suffer early malnutrition becomes progressively more abnormal. Indeed, "suboptimal head circumference may be the most sensitive physical index of prolonged undernutrition during infancy." Sometimes, however, head circumference is relatively preserved.

In some children, the combination of neglect and malnutrition results in psychosocial dwarfism. Biochemical tests in these children are indistinguishable from those seen in idiopathic hypopituitarism (condition resulting from a deficiency in pituitary hormone), including abnormalities of growth hormone, ACTH (adrenocorticotropic hormone. which activates cortisol production), and thyroid function. The children are short, appear younger than their chronological age (immature facial features and body structure), and have delayed dental and bone ages. Some children have widened cranial sutures (sutures between the bones of the skull). In extreme cases, children exhibit bizarre eating and drinking behavior, sleep disturbances with nighttime roaming, and foraging (beyond the usual post-adoption arrival behaviors).


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