How do you fix kwashiorkor disease? A phased guide to nutritional rehabilitation

October 29, 2025 •

4 min read

According to the World Health Organization, severe malnutrition is a major cause of child mortality, with kwashiorkor being a specific, life-threatening form caused by protein deficiency. Learning how do you fix kwashiorkor disease is critical, requiring a structured, multi-phase medical and nutritional approach to reverse its devastating effects and restore health.

Quick Summary

Kwashiorkor is treated through a cautious, phased medical and nutritional rehabilitation process involving stabilization, specialized therapeutic feeding, and ongoing dietary support to promote recovery and prevent relapse.

Key Points

Prioritize Stabilisation: Initial treatment focuses on correcting hypoglycemia, hypothermia, dehydration, and infections before initiating full nutritional rehabilitation.
Start Cautious Refeeding: Specialized formulas are used first to avoid potentially fatal refeeding syndrome.
Provide Essential Micronutrients: Vital vitamins and minerals like vitamin A and zinc are supplied early, but iron is typically delayed until the recovery phase.
Introduce Protein Gradually: Once stable, higher-energy foods like therapeutic formulas or RUTF are used for catch-up growth, carefully increasing protein intake.
Ensure Follow-Up Care: Long-term recovery requires ongoing monitoring, nutrition education for caregivers, and a diverse, balanced diet to prevent relapse.
Utilize Therapeutic Foods: Ready-to-Use Therapeutic Foods (RUTFs) are crucial for transitioning to outpatient care, providing dense nutrition in a safe, shelf-stable format.

Kwashiorkor is a severe form of protein-energy malnutrition, most often affecting children in developing countries where diets are high in carbohydrates but critically low in protein. The disease's most visible symptom, edema (fluid retention), can deceptively mask the underlying muscle wasting and weight loss. A comprehensive, phased treatment plan, often based on protocols established by the World Health Organization (WHO), is essential for successful recovery and preventing life-threatening complications like shock, organ failure, and infections.

Understanding the phased treatment approach

The management of kwashiorkor is a complex process that moves through several distinct phases. Rushing the nutritional component, particularly by introducing too much protein too quickly, can be dangerous and even fatal, leading to a condition called refeeding syndrome.

Phase 1: Initial Stabilisation (Days 1–7)

The first week of treatment focuses on correcting immediate, life-threatening issues without overstressing the already compromised body. Key priorities include:

Treating/Preventing Hypoglycemia: Malnourished individuals have low energy reserves. Frequent feeding or glucose solutions are given to maintain blood sugar levels and prevent this common complication.
Treating/Preventing Hypothermia: A malnourished body struggles to regulate its own temperature. Patients must be kept warm and protected from drafts.
Treating/Preventing Dehydration: Rehydration must be done slowly and carefully. A special formula, ReSoMal (Rehydration Solution for Malnutrition), is used to correct fluid loss while addressing the unique electrolyte imbalances of kwashiorkor, which differ from standard rehydration needs.
Correcting Electrolyte Imbalances: Kwashiorkor causes severe electrolyte abnormalities, notably low potassium and magnesium. These are corrected as part of the rehydration and initial feeding plan.
Treating/Preventing Infection: Due to a severely compromised immune system, all malnourished children are at high risk of infection. Broad-spectrum antibiotics may be given.
Cautious Feeding: Refeeding is initiated carefully to prevent refeeding syndrome. Specialized formula for initial feeding may be used. Feeds are given in small, frequent amounts.
Correcting Micronutrient Deficiencies: Vitamin and mineral supplements, such as vitamin A and zinc, are provided immediately. Iron supplementation is typically delayed until the rehabilitation phase to avoid complications.

Phase 2: Rehabilitation (Weeks 2–6)

Once the patient is stable, medically sound, and has regained their appetite, the focus shifts to restoring nutritional status and promoting rapid weight gain. This is where the term “catch-up growth” is most relevant.

Introducing Higher-Energy Foods: The diet is transitioned to a higher-energy, higher-protein formula, or to Ready-to-Use Therapeutic Food (RUTF). RUTFs are particularly valuable because they are shelf-stable, do not require water, and can be given to patients at home.
Encouraging Appetite: The patient's appetite, which was likely poor or non-existent in the stabilization phase, is now the main driver for increasing food intake.
Initiating Iron Supplementation: With steady weight gain and improved appetite, iron may be introduced to treat any underlying anemia.
Providing Sensory Stimulation and Emotional Support: For children, malnutrition can cause apathy and developmental delays. Gentle stimulation and emotional support are crucial for psychological recovery.

Phase 3: Long-term recovery (Beyond 6 weeks)

This phase focuses on transitioning the patient back to a standard, healthy diet and ensuring the underlying causes of malnutrition are addressed.

Dietary Transition: The patient is weaned off therapeutic foods and onto a normal, varied diet rich in protein, calories, and micronutrients.
Nutrition Education: Education and counseling are provided to caregivers on proper nutrition, food hygiene, and cooking techniques to prevent future malnutrition.
Follow-up Care: Ongoing monitoring of the patient’s growth and overall health is essential to ensure full recovery and prevent relapse.

The nutritional toolkit for recovery

The recovery from kwashiorkor depends on a careful selection of therapeutic and transitional foods. These include:

Therapeutic Formulas: Milk-based formulas developed by the WHO, used in inpatient settings. Different formulas are used for initial stabilization and later catch-up growth.
Ready-to-Use Therapeutic Food (RUTF): A high-energy, protein-dense paste, typically made from peanuts, milk powder, sugar, and oil, fortified with vitamins and minerals. RUTFs have revolutionized the treatment of severe acute malnutrition by enabling outpatient care.
Locally Sourced Foods: In the final stages, a diverse, balanced diet is key. Some examples of locally available, nutrient-dense foods in affected regions include cowpeas, pigeon peas, eggs, lean meats, and fortified cereals.

Kwashiorkor vs. Marasmus: A comparison


Feature	Kwashiorkor	Marasmus
Primary Deficiency	Protein deficiency, with adequate or near-adequate calorie intake.	Overall energy and calorie deficiency, including protein.
Key Symptom	Edema (swelling), particularly in the belly, feet, and ankles.	Severe wasting and emaciation, with significant loss of body fat and muscle.
Physical Appearance	Bloated or swollen appearance, which can hide weight loss.	Skinny, shrunken appearance with visible bones and wrinkled skin.
Appetite	Often apathetic and has a poor appetite.	May be hungry, but can also develop anorexia.
Hair and Skin	Hair may become sparse, brittle, and discolored. Skin can develop lesions or change pigment.	Hair is typically dry and brittle. Skin is thin and dry.
Liver	Often develops a fatty liver.	Liver is typically not affected in the same way.

Conclusion

To effectively fix kwashiorkor disease, a prompt, comprehensive, and phased approach is essential. This medical and nutritional rehabilitation process, guided by established protocols like those from the WHO, addresses not only the immediate life-threatening complications but also the long-term recovery needs. While early treatment can lead to a full recovery, delayed intervention can result in permanent physical and intellectual disabilities. Therefore, alongside medical care, sustained nutritional support and education are critical to ensuring full healing and preventing relapse in vulnerable populations. For more comprehensive guidance on severe acute malnutrition, resources such as the NCBI book chapter on the Pocket Book of Hospital Care for Children are invaluable.

Frequently Asked Questions

Refeeding syndrome is a potentially fatal condition that can occur when a severely malnourished person is fed too aggressively. It involves a dangerous shift in fluids and electrolytes, particularly potassium and magnesium, which can lead to heart failure and other complications. Cautious, gradual refeeding is essential to prevent it.

Kwashiorkor is caused primarily by protein deficiency and is characterized by edema (swelling), while Marasmus is caused by an overall deficiency of calories and energy, resulting in severe wasting and emaciation.

RUTFs are energy-dense, vitamin-enriched, and mineral-fortified food pastes, often peanut-based, that are safe to use at home. They do not require cooking or refrigeration and are critical for the rehabilitation phase of treatment.

While early and effective treatment can lead to full recovery, delayed treatment, particularly in children, may result in permanent physical and mental disabilities, including stunting of growth.

While most common in children, kwashiorkor can occur in adults who have a severely restricted diet. This is rare in developed countries but can be a sign of neglect, child abuse, or underlying medical conditions like HIV.

Iron supplementation is typically delayed until the rehabilitation phase because it may exacerbate infections during the initial stabilization phase when the body's systems are severely compromised.

Severe malnutrition can lead to apathy and developmental delays, especially in children. Providing emotional support and sensory stimulation is an important part of the rehabilitation process to aid in psychological and neurological recovery.