Critical training to better protect, support, and heal vulnerable children




When we're thinking about malnutrition, we often start to think of that stereotypical image of a very emaciated child. For example, the big belly that happens because of kidney damage. Or, that sickly pallor look that we often see when we think of malnutrition.

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That doesn't happen overnight. There's often stages before we get to that really extreme image. I think it's really important, especially for caregivers who are with the children every day and observing them every day to understand those different nuances and when it might be a good idea to bring attention to a medical professional.

More obvious symptoms would be if you're noticing that a child is not changing in stature. Often, we'll see children that look like they're four or five years old, but they're actually eight or nine years old. There's significantly stunted growth in those cases.

Another thing to look out for is bone malformations. Sometimes you'll see bowing of the legs. You might see changes in head formation where parts of the skull might be protruding in a less natural way. That often means that the bones aren't adequately forming. Maybe there are not enough minerals in their diet to have good bone formation or they're not keeping up with the growth that they need to be at.

Another thing to look out for would be teeth and the way their teeth come in. Often children who are malnourished may not have enough teeth coming in fast enough. That, similarly, has to do with mineral density and adequate nutrition.

Less obvious signs and symptoms might be their skin. For example, skin texture changes, scaliness rashes, bumps--things like that--can indicate that there are nutrient deficiencies. The color of their eyes--clouding of the eyes or yellowness in the parts that should be white--is an indication that there might be nutrient deficiencies or malnutrition happening.

You want to also look at their tongue. You might notice the tongue is really swollen. It might have ridges in it. You might notice that there's discoloration. There's something called geographic tongue where you'll see patterns of a different color on the tongue. It looks unnatural.

Another thing to look out for is their fingernails. You might notice ridging or the shape might be, might be flat--instead of being rounded. You might also notice that the white [crescent] part might be extended. Rather than it being a pink or paler color, you might notice that it's white throughout the nail. Those can be indications of some sort of nutrient deficiency that might be going on with the child.


Lara Zakaria, RPh MS CNS CDN

Lara Zakaria is a Syrian-American pharmacist and clinical nutritionist residing in New York City. She owns Foodie Farmacist LLC, an integrative medicine, nutrition, and genomics consulting practice focused on prevention and reversal of chronic disease. An active member of...

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The Syrian American Medical Society (SAMS) Tristate Chapter, she is also honored to serve on the national Board of Directors.

Her ground experience includes participating with multidisciplinary medical teams serving displaced refugees and underserved local communities in Jordan and Lebanon. Lara also serves on several advisory committees including the Jordan Relief Committee (including the Za’atri Clinic Advisory Commission), Advocacy, and as chair of the Pharmacy and Nutrition Committee. Lara is an active advocate for awareness of the Syrian Crisis and medical worker safety, meeting with representative of the United Nations and of the US congress and senate, as well as in presenting SAMS work at various universities and roundtable discussions including the University of Michigan, Columbia University, CUNY Medical School, and New York University Medical and Law School.

Lara is currently a graduate student at the George Washington University Milken Institute School of Public Health, and a candidate for a Masters in Public Health with a special interest in Behavioral and Social Health.


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