What is the clinical sign of Kwashiorkor?

Appeared in: BTSC Staff Nurse 31 July-2025

Explanation

The Flag sign is a characteristic finding in children with Kwashiorkor, a form of severe protein-energy malnutrition.
It manifests as alternating bands of hypopigmented (light-colored) and normally pigmented hair.
This pattern reflects periods of malnutrition followed by periods of improved nutrition.
During protein-deficient states, melanin synthesis in the hair follicles is impaired, resulting in the light-colored bands.
When protein intake improves, normal pigmentation resumes, creating the darker bands.

Option A: Turner sign (or Grey Turner's sign) is not associated with malnutrition. It indicates retroperitoneal hemorrhage (bleeding behind the abdominal cavity).
Option B: Fox sign is also a sign of retroperitoneal hemorrhage and is unrelated to Kwashiorkor.
Option C: Cullen sign is a sign of intraperitoneal hemorrhage (bleeding within the abdominal cavity), not malnutrition.

Clinical Relevance

Nursing practice connection: Knowing Clinical signs of Kwashiorkor helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Early recognition of the Flag sign in a child should prompt a thorough nutritional assessment for severe protein malnutrition.
This finding, along with others like bilateral pitting edema, 'flaky paint' dermatosis, and apathy, helps a nurse differentiate Kwashiorkor from Marasmus (severe energy deficiency), which presents with severe wasting but no edema.
Nursing care for a child with Kwashiorkor involves careful refeeding to prevent refeeding syndrome, monitoring fluid and electrolyte balance, managing skin breakdown, and providing psychosocial support.

How to Approach the Question

First, identify the core concept of the question, which is 'Kwashiorkor'.
Recall the key clinical features of Kwashiorkor. The most prominent are bilateral pitting edema, skin changes ('flaky paint' dermatosis), and hair changes.
Evaluate each option. Turner sign, Fox sign, and Cullen sign are all related to hemorrhage, typically from pancreatitis or trauma.
Recognize that these three signs involve bruising (ecchymosis) in specific locations (flanks, groin, umbilicus) and are not related to nutritional deficiencies.
Identify 'Flag sign' as the specific hair change (alternating pigmented bands) associated with the fluctuating nutritional status in Kwashiorkor.
Therefore, select Flag sign as the correct answer.

Concept Tested & Keywords

Q4-6lGZNTKA2nJYUbf4zH8

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 471-473

Practise the full BTSC Staff Nurse 31 July-2025

Attempt every question from this paper in a timed mock, then review the full solution for each one.