R.J.
Doctor.
Parasites of many types
Malnutrition (kwashiorkor comes to mind)
Twisted Intestine
Partial blockage
Enlarged : liver, spleen, gallbladder...pick an organ, any organ
Lymphatic system
Certain tumors
Certain cancers
And about 66 other things....
OR completely normal
Only a doctor who can SEE him, examine him, and run lab years will be able to tell you whether its a minor, major, or no problem.
MY first thought is kwashiorkor. But that's because I've lived in areas where kids never get meat, and live off carbohydrates (casava, pasta, and potatoes, mostly). Without an exam and history, there's no way to tell what's wrong.