When a child is malnourished, the initial symptoms will be simple weight loss or stagnancy of weight gain. A child may demonstrate more severe symptoms, such as seizures related to low blood sugar or electrolyte imbalances, when the malnutrition is severe or prolonged. A child with underlying conditions may demonstrate these symptoms with even mild malnutrition or in acute circumstances, making it difficult to determine the true cause.
Severe cases that are prolonged will cause significant delays in development as well as psychological scarring. An example is the recent case in Denver from October of 2013 where 4 children ages 2-6 were found unable to speak and their ages were difficult to determine due to severe and prolonged abuse and neglect. This case was the extreme and not what you will commonly see, even in the criminal courts.
The cases that we have reviewed here at Godoy Medical Forensics have been much more subtle, where a diagnosis was made after several months or even years of assessment and care by the healthcare providers. Underlying conditions such as Down syndrome and other genetic disorders, endocrine disorders and blood disorders complicate the analysis of these cases. Underlying conditions like these make it difficult to determine if the child is also being intentionally malnourished on top of their disorder affecting the body’s ability to metabolize nutrients. In each case, the child had difficulty gaining weight and demonstrated the symptoms thought to be from withholding food, even while hospitalized.