These severely malnourished children have clinical features of both marasmus and kwashiorkor. They are severely underweight (below 60% of the 50th centile) but also have oedema. Children with marasmus may rapidly deteriorate, especially if they develop an infection, and present with oedema to become marasmic kwashiorkor.
Using the Wellcome classification of PEM, children who have marasmic kwashiorkor have a weight which is below 60% of the median (50th centile) and also have oedema.