Unless urgent, treatment of malaria or other parasitic infections should be postponed until the patient is clinically improved. Anemia is usually mild and responds to oral protein, iron, and folic acid supplements. Death in the first days of treatment is usually due to electrolyte imbalance, infection, hypothermia, or heart failure. Long-term effects of malnutrition in childhood are not fully understood. In the adequately treated case the liver probably recovers fully without subsequent cirrhosis.
Humoral immunity is usually unimpaired.
Cell-mediated immunocompetence is markeldy compromised in the acute phase but is restored with recovery. Behavioral development may be markedly retarded in the severely malnourished child. The degree of mental impairment is related to the duration of malnutrition and age of onset. The infant with marasmus is affected most severely than the other child with kwashiorkor. Prospective studies suggest that a relatively mild degree or mental retardation persists into school age.