title: Severe protein-calorie malnutrition in two brothers due to abuse by starvation.
abstract: OBJECTIVE
  To describe the case of two siblings with severe protein-calorie malnutrition due to abuse by starvation.
  
  
  METHODS
  The two patients were simultaneously referred from the Municipal Hospital, where they were admitted to the Pediatric Gastroenterology clinic of a university hospital for diagnostic investigation of the cause of severe malnutrition and screening tests for Celiac Disease, Cystic Fibrosis and Environmental enteropathy among others. The exams were all normal, and after detailed research on the interactions of this family, we reached the conclusion that the malnutrition was due to abuse by starvation. The children spent approximately two months in the hospital, receiving a high-protein and high-calorie diet, with significant nutritional recovery.
  
  
  CONCLUSIONS
  Abuse by starvation, although rare, should always be considered of as one of the causes of child malnutrition and pediatrician should be aware of the child's development, as well as the family interactions, to prevent more severe nutritional and emotional consequences in the future.
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil. Electronic address: marcela_montenegro_@hotmail.com.
authors.forename: Marcela Montenegro Braga
authors.initials: MM
authors.lastname: Barroso
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.
authors.forename: Luiza Martins
authors.initials: LM
authors.lastname: Salvador
authors.affiliation: Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.
authors.forename: Ulysses
authors.initials: U
authors.lastname: Fagundes Neto
mesh_terms: D002648:Child; D002649:Child Abuse; D002675:Child, Preschool; D006801:Humans; D008297:Male; D011502:Protein-Energy Malnutrition / Q000209:etiology*; D012720:Severity of Illness Index; D035781:Siblings; D013217:Starvation / Q000150:complications*
keywords: Child abuse; Deficiências nutricionais; Desnutrição proteico‐calórica; Maus‐tratos infantis; Nutritional deficiencies; Protein‐energy malnutrition