Which refers to the alternating bands of pigmentation in the hair of a child suffering from kwashiorkor?

BTSC Staff Nurse 31 July-2025

Child Health Nursing (Pediatrics)

Easy

Appeared in: BTSC Staff Nurse 31 July-2025

Explanation

Flag sign refers to the alternating bands of depigmented (light) and normally pigmented (dark) hair.
This sign is a classic manifestation of kwashiorkor, a severe form of protein malnutrition.
The bands form due to alternating periods of poor protein intake (causing depigmentation) and adequate nutrition (restoring normal pigmentation).

Option A: Phalen sign is a provocative test used to diagnose carpal tunnel syndrome. It involves wrist flexion and is related to nerve compression, not nutritional status.
Option B: Fox sign is a sign of retroperitoneal hemorrhage, indicated by bruising over the inguinal ligament. It is associated with conditions like severe acute pancreatitis, not malnutrition.
Option C: Tinel sign is elicited by tapping over a nerve to check for irritation or regeneration. It is commonly used to assess for carpal tunnel syndrome or other nerve entrapment syndromes.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of protein-energy malnutrition (Kwashiorkor) as background academic context rather than a clinical decision trigger.
Observing Flag sign is a critical nursing assessment finding that points directly to a history of severe, intermittent protein malnutrition, prompting immediate action.
This finding mandates a comprehensive nutritional assessment, initiation of a high-protein diet, and education for the family on proper nutrition.
What if? If a child's hair was diffusely sparse and light-colored (hypopigmented) without distinct bands, it would still suggest malnutrition (often seen in marasmus or general protein deficiency), but the specific 'Flag sign' pattern points to an alternating nutritional history characteristic of kwashiorkor.

How to Approach the Question

First, identify the key terms in the question: 'alternating bands of pigmentation,' 'hair,' and 'kwashiorkor.'
The question asks for the specific name of this clinical sign, indicating a need for factual recall of medical terminology.
Systematically evaluate each option against the clinical picture described.
Recall or deduce the meaning of each sign. Phalen and Tinel signs are related to nerve compression tests, primarily for carpal tunnel syndrome. Fox sign is related to pancreatitis.
Flag sign is the term that specifically describes the hair changes seen in kwashiorkor due to fluctuating nutritional status.
Therefore, by eliminating the unrelated neurological and abdominal signs, Flag sign is identified as the correct answer.

Concept Tested & Keywords

Concept Tested: Clinical signs of protein-energy malnutrition (Kwashiorkor)
Stem keywords: alternating bands, pigmentation, hair, kwashiorkor
Lead-in keywords: Which refers to
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 2000-2002