In southern and eastern Africa, where approximately eight per cent of households lack access to adequate food, children suffering from chronic infections such as tuberculosis, gastrointestinal parasites and human immunodeficiency virus, often present with severe protein energy malnutrition. Three cases are described of children presenting to Chikankata Salvation Army Hospital who required hospitalization and urgent feeding due to PEM. No underlying aetiology for their life-threatening PEM could initially be identified and they were all observed to gain weight while in the intensive feeding unit. After discharge, each re-presented with recurrent failure-to-thrive and were found to have subtle neurologic deficits and underlying epilepsy. Epilepsy and developmental disabilities should be considered in patients with PEM for whom other aetiologies cannot be identified.