A child brought to casualty shows sunken fontanelle, loose skin, gross muscle wasting, apathy, and age-inappropriate weight of 45% expected for age. There are old, healing pressure sores and no acute injury. This presentation is MOST consistent with:

• A Kwashiorkor due to protein deficiency in an otherwise adequately fed child
• B Wasting syndrome secondary to congenital immunodeficiency
• C Child neglect with chronic nutritional deprivation causing marasmus-like picture ✓
• D Gastroenteritis with dehydration

Explanation

Weight at 45% of expected, extreme muscle wasting (marasmic features), healing pressure sores indicating prolonged immobility, and apathy in a child — in the absence of a primary medical cause — are classical signs of child neglect. Neglect is defined as the persistent failure to meet a child's basic physical and/or psychological needs. Pressure sores in a child reflect prolonged immobilisation without repositioning, which is a hallmark of neglect. Kwashiorkor presents with oedema and skin changes. Congenital immunodeficiency and gastroenteritis do not produce this combination of findings.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.