Ninety-nine children admitted to the Instituto Materno Infantil de Pernambuco with severe malnutrition from May 1999 to May 2000 were investigated in a cross-sectional study focusing on key epidemiological and clinical variables. The majority of the children (88.9%) were less than 6 months of age, 42.4% had a history of low birth weight, and 36.4% were premature. Some 19.2% had never been breastfed, and 49.5% had been breastfed for less than 2 months. Some 15.2% of the mothers were illiterate. Most of the families (86.1%) had incomes less than twice the minimum wage (approximately US$150/month), and 51.5% had migrated from rural areas. Only 26.3% of the homes had running water, and 40.4% lacked sewage disposal facilities. Diarrhea was the reason for hospital admission in 55.6% of the cases. Hospital mortality was 34.3% in this group.