Marasmus is a form of emaciation and wasting in an infant due to protein-energy malnutrition. It is characterized by growth retardation in weight more than height so that the head appears quite large relative to the body. There is a progressive wasting of subcutaneous fat and muscle so that the skin appears loose. Severe prolonged marasmus may result in permanent retardation. Marasmus is common in Third World countries in situations with poor access to protein-rich food sources or where unsanitary water is associated with severe infant diarrhea and a corollary inability to absorb nutrients. The term "marasmus" is also used as roughly equivalent to "anaclitic depression," a term coined by René Spitz to refer to children who suffer from the early loss of a mother without a suitable substitute. Thus, marasmus has come to be associated with parental abuse or neglect that results in a failure to thrive. In some cases parents are unin-formed regarding nutritional or emotional needs of children or are unable to provide sustenance because of poverty. In other cases such failure to thrive stems from emotional deprivation as a result of parental withdrawal, rejection, or hostility. It is hypothesized that the emotional experiences of the child lead to shifts in the production of growth hormone.
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