Malaria continues to pose a major global health risk, especially in the tropics and subtropics. The most susceptible population, children below five years, are most at risk of fatal malaria illness and mortality. This susceptibility is not by chance but based on biological, immunological, and physiological explanations. Malaria might be a preventable disease, but it continues to take a heavy toll on children. Despite progress in treatment and awareness, this age group remains the most vulnerable. But why are these little ones at such high risk?

"The answer lies in their biology," explains Dr Rashmi Bhardwaj, Senior Consultant and Incharge of the Pediatric Intensive Care Unit (PICU) at Marengo Asia Hospital, Gurugram. "Children under five have immature immune systems that haven’t had the chance to build any kind of defence against malaria," she further added.

Life-Threatening Complications

That lack of immunity means that when malaria strikes, it hits hard. Unlike in older people, where symptoms may unfold more gradually, the disease can progress with alarming speed in younger children.

"Malaria in a toddler or infant can escalate into complications like cerebral malaria — where the brain is affected — or severe anaemia due to the destruction of red blood cells," says Dr Bhardwaj. "These can be life-threatening if not treated immediately."

Dehydration

Another major concern is that young children have lower fluid reserves. With symptoms like high fever, sweating, vomiting, and diarrhoea, dehydration can set in quickly — and dangerously.

“Dehydration is not just a side-effect; it’s a serious complication in itself,” Dr Bhardwaj adds. “In children under five, even mild dehydration can rapidly worsen their condition. That’s why timely intervention is key.”

Higher Parasite Burden Means Faster Deterioration

To make matters worse, younger children tend to carry a higher parasite burden — meaning more malaria parasites in their bloodstream compared to adults or older children who may have some immunity.

“In my experience at the Pediatric ICU, we often see that by the time parents bring in their child, things have already escalated. The fever might have started just a day ago, but in a child under five, 24 hours can make a huge difference,” Dr Bhardwaj warns.

Prevention Is Possible

The good news is that malaria is highly preventable. Parents can take simple, effective steps to protect their children.

“Make sure your child sleeps under an insecticide-treated bed net every night. Avoid outdoor play from dusk to dawn when mosquitoes are most active. Dress them in long sleeves and pants, and use mosquito repellents approved for children. Also, make your home mosquito-proof by using screens and eliminating stagnant water,” advises Dr Bhardwaj.

Stay Alert

In the end, awareness and quick action are key. “Any fever in a child under five, especially in malaria-prone areas, should be taken seriously. Don’t wait. Get medical attention immediately,” says Dr Bhardwaj.

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