Definition

During digestion, the body breaks down food into smaller molecules, allowing the nutrients to be absorbed and distributed. Malabsorption is a condition where food is not absorbed properly, affecting the intake of macronutrients (carbohydrates, proteins, fats) and micronutrients (vitamins and minerals). Malabsorption in children is rare. 

Malnutrition can lead to weight loss, underweight, and failure to thrive due to a lack of nutrients. The small intestine, which is responsible for nutrient absorption, is the primary organ affected by this disorder.

Causes

Various conditions may lead to malabsorption in children, including:

• Celiac disease: A genetic disorder and the most common cause of malabsorption, particularly affecting girls.
• Cystic fibrosis: The second most common cause of malabsorption in children.
• Crohn's disease: Causes inflammation in the digestive tract.
• Lactose intolerance: A common issue in infants and young children under 3 months, where lactose in dairy products cannot be processed properly.
• Chronic pancreatitis: Inflammation of the pancreas.
• Short bowel syndrome
• Pernicious anemia
• Food allergies
• Cancer

Often, malabsorption occurs when children lack the necessary enzymes to digest certain foods. For instance, lactose intolerance results from insufficient enzymes to absorb lactose. In Celiac disease, undigested gluten injures the small intestine. Short bowel syndrome can also hinder proper nutrient absorption due to reduced intestinal length.

Risk Factor

Malabsorption may be genetically inherited, such as with cystic fibrosis or a family history of malabsorption. Other risk factors include:

• Celiac disease
• Cystic fibrosis
• Crohn's disease

Additional risk factors involve:

• Long-term use of antibiotics or laxatives
• History of digestive surgery
• Travel to areas endemic with digestive parasites

Symptoms

Malabsorption symptoms in children are primarily digestive in nature, including:

• Recurrent abdominal cramps or pain.
• Chronic diarrhea, leading to dehydration and malnutrition.
• Weight loss.
• Bloating, nausea, and vomiting (sometimes with bloody stools).
• Failure to thrive and poor appetite.
• Persistent fatigue.
• Oily, foul-smelling stools.
• Easy bruising, skin rashes, and brittle bones due to low bone density.

Beyond digestive symptoms, malnutrition can lead to dehydration, which is dangerous for children. Signs of dehydration include:

• Increased thirst.
• Reduced urination.
• Lack of energy.
• Dry mouth.
• Absence of tears when crying.
• Reduced skin elasticity (skin returns slowly to its original shape after being gently pinched).
• Sunken eyes.

Diagnosis

Diagnosing malabsorption can take time due to the wide variety of potential causes. Generally, the doctor will begin by asking about the child’s dietary history, including the types and quantities of food and fluids consumed. Parents or caregivers may be asked to record the child’s meals and drinks for one week. In addition to a medical history review and physical exam, the doctor may recommend further diagnostic tests, such as:

• Blood tests: To detect disorders like celiac disease or assess nutritional deficiencies.
• Radiology exams: X-rays or CT scans to examine the digestive system.
• Endoscopy and biopsy: To assess the surface of the intestines for inflammation or infection.
• Stool analysis: Stool from children with malabsorption may show high levels of sugars or fats.
• Sweat test: To diagnose cystic fibrosis.
• Hydrogen breath test: Elevated hydrogen levels could indicate lactose intolerance.

Management

Treatment for malabsorption depends on the underlying cause. Therapy will be tailored to address the specific cause, such as managing chronic diarrhea, providing vitamins and supplements to support the child's health, and treating any inflammation. Doctors will monitor the child’s growth and development regularly. It is important for parents to follow dietary recommendations and administer medications as prescribed to manage symptoms.

The healing process for the intestinal lining typically takes 3-4 days, but for some patients, it can take up to 2 months. Many disorders causing malabsorption are progressive, which can shorten the patient's life expectancy compared to the general population.

Complications

If left untreated, malabsorption in children can lead to complications, such as:

• Increased susceptibility to infections.
• Reduced bone density (osteoporosis), making fractures more likely.
• Stunted growth and weight gain.
• Malnutrition, which can weaken the immune system.
• Liver problems.

Greater complications can occur in children whose malabsorption-related conditions are not treated or managed properly.

Prevention

Malabsorption cannot always be prevented, especially if it is linked to genetic or chronic conditions. However, parents can help prevent complications by closely monitoring their child's health, being alert to warning signs, and maintaining regular check-ups with their healthcare provider. It is also important to consult a doctor before starting any special diets.

When to See a Doctor?

If a child experiences persistent, large-volume diarrhea that does not improve, it is essential to seek medical attention promptly. Seek immediate care if:

• Diarrhea lasts more than 24 hours.
• Diarrhea is accompanied by fever.
• The child has severe abdominal or rectal pain.
• The stool contains blood or pus.
• The stool is dark and tar-like.
• Diarrhea is accompanied by symptoms of dehydration.

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