Kwashiorkor is still not fully understood.

).Williams identified the condition as being associatedwith the social situation of the affected child in the family:kwashiorkor occurs in the “neglected” child, and thus the mainaim of prevention and management should be to overcomethis neglect. Most research on nutritional concepts has focusedon biomedical aspects — pathogenesis, symptomatology, clini-cal course, and cell, tissue and organ failure — and appropriatemedical care; research on social aspects is far less prominent, eventhough care for families with a child suffering from kwashiorkorhas the potential to prevent and manage the disease effectively.Concentration on pathological and physiological factors andcurative medical care takes only a short-term view, and the role ofhome visits and support has been recognized mainly in respectof preventing relapse. It is perhaps not easy for social paediatricpractice to be accepted into scientific research.Seventy years later, Williams’s description of the conditionis still valid. The 90% mortality reported in 1935 has declined— but by nowhere near as much as one could have expected.Kwashiorkor still has a high case-fatality rate in many places, andit is still true that most children die after initiation of treatment.This situation requires us to reassess continually our knowledgeabout the disease and our approach to its management.Williams described the typical development of the disease,the critical period being the second year of life when other foodsare introduced and breastmilk is gradually replaced by a diet offoods suitable for intake and digestion by young children.Among the symptoms mentioned by Williams, peripheraloedema and skin lesions predominate. The clinical appearanceof hypopigmentation, hyperpigmentation and desquamationwas her main focus for the differential diagnosis, and this view ismaintained to the present day. As Latham pointed out, “when‘flaky paint’ dermatosis is seen in a malnourished child withoedema, it is pathognomonic of kwashiorkor” (