If you're raising a picky eater, you might worry that your child isn't getting the nutrients necessary for

proper growth and development.

But you probably don't need to worry unless your doctor tells you that your child isn't growing at the
normal rate for that age range. Over time, most finicky eaters do get enough calories and nutrients to
meet their needs.

What Are Hunger and Malnutrition?

Everyone feels hungry at times. Hunger is the body's signal that it needs food. Once we've eaten
enough food to satisfy our bodies' needs, hunger goes away until our stomachs are empty again.

Malnutrition is not the same thing as hunger, although they often go together. People who are
chronically malnourished lack the nutrients needed for proper health and development. Someone
can be malnourished for a long or short period of time, and the condition may be mild or severe.
People who are malnourished are more likely to get sick and, in severe cases, might even die.

Chronic hunger and malnutrition can cause significant health problems. People who go hungry all
the time are likely to be underweight, weighing significantly less than an average person of their size.
If malnourished as a child, their growth may also be stunted, making them much shorter than
average.

Causes of Hunger and Malnutrition

People who don't get enough food often experience hunger, and over the long term this can lead to
malnutrition. But someone can become malnourished for reasons that have nothing to do with
hunger. Even people who have plenty to eat may be malnourished if they don't eat foods that
provide the right nutrients, vitamins, and minerals.

Some diseases and conditions prevent people from digesting or absorbing their food properly. For
example:

o Someone with celiac disease has intestinal problems that are triggered by a protein

called gluten, which is found in wheat, rye, and barley.
o Kids with cystic fibrosis have trouble absorbing nutrients because the disease affects
the pancreas, an organ that normally produces enzymes necessary for digestion.

Someone who doesn't get enough of one specific nutrient has a nutritional deficiency, a form of
malnutrition (although it doesn't necessarily mean the person will become seriously ill). The most
common nutritional deficiency in the world is iron deficiency, which can lead to anemia.

Who Is at Risk for Malnutrition?

All over the world, people who are poor or who live in poverty-stricken areas are at the greatest risk
for hunger and malnutrition. In poor countries, wars and natural disasters such as droughts and
earthquakes also can contribute to hunger and malnutrition by disrupting normal food production and
distribution.

In the United States, food manufacturers fortify some common foods with vitamins and minerals to
prevent certain nutritional deficiencies. For example, the addition of iodine to salt helps prevent
 some thyroid gland problems (such as goiter), folic acid added to foods can help prevent certain birth
defects, and added iron can help prevent iron-deficiency anemia.

Malnutrition affects people of every age, although infants, children, and teens may suffer the most
because many nutrients are critical for normal growth and development. Older people may develop
malnutrition because aging, illness, and other factors can lead to a poor appetite, so they may not
eat enough.

Alcohol can interfere with nutrient absorption, so alcoholics might not benefit from the vitamins and
minerals they consume. People who abuse drugs or alcohol can be malnourished or underweight if
they don't eat properly.

Children and teens on special diets — such as vegetarians — need to eat balanced meals and a
variety of foods to get the right nutrients. Vegetarians and vegans, for example, should make sure
they get enough protein and vitamins like B12.

Symptoms and Effects of Malnutrition

Malnutrition harms both the body and the mind. The more malnourished someone is — in other
words, the more nutrients that are missing — the more likely he or she is to have problems.

The signs and symptoms of malnutrition depend on which nutritional deficiencies a person has,
although they can include:

o fatigue (tiredness) and low energy

o dizziness
o poor immune function (which can harm the body's ability to fight off infections)
o dry, scaly skin
o swollen and bleeding gums
o decaying teeth
o slowed reaction times and trouble paying attention
o underweight
o poor growth
o muscle weakness
o bloated stomach
o osteoporosis, or fragile bones that break easily
o problems with organ function
o problems learning

If a pregnant woman is malnourished, her child may weigh less at birth and have a lower chance of
survival.

Vitamin A deficiency from malnutrition is the chief cause of preventable blindness in the developing
world, and kids with severe vitamin A deficiency have a greater chance of getting sick or dying from
infections such as diarrhea or measles.

Iodine deficiency can cause mental retardation and delayed development. Iron deficiency in infancy
can delay development and make older kids less active and less able to concentrate. Teens who are
malnourished often have trouble keeping up in school.

Treating Malnourished Children

 Fortunately, many of the harmful effects of malnutrition can be reversed, especially if a child is only
mildly or briefly malnourished.

If you think your child isn't getting enough of the right nutrients, talk to your doctor, who may perform
a physical exam and ask about the types and amounts of food your child eats. The doctor may also:

o measure height, weight, and body mass index (BMI) to see if they're within a healthy
range for your child's age
o check for underlying conditions that could cause malnutrition
o order blood tests to check for nutritional deficiencies
o order additional tests based on your child's medical history and physical exam

Treatment for malnutrition depends on its cause. A doctor or dietitian might recommend specific
changes in the types and quantities of foods your child eats, and may prescribe dietary supplements,
such as vitamins and minerals.

If there's an underlying problem causing the malnutrition, the doctor will help you find ways to ensure
your child gets the necessary nutrients.

Can a Picky Eater Become Malnourished?

Parents often worry that kids who seem to live on peanut butter sandwiches or hide at the sight of
vegetables might not eat enough to stay healthy. Few kids in the United States and other developed
nations experience severe malnutrition like that seen in Third World countries. Even finicky eaters
usually get enough calories and nutrients.

The best way for parents to make sure that kids are properly nourished is to serve a variety of
healthy foods and limit unhealthy snacks. If you're concerned that your child's energy level is lagging
or that he or she isn't growing normally, share your concerns with your doctor.