If failure to gain weight adequately does not respond to management at a primary care clinic, the child must be referred for further assessment and management. This is particularly important in children with a weight that falls or crosses centiles.
Usually these children are referred to a special nutritional clinic where the following steps should be followed:
- Exclude any chronic illness such as tuberculosis or HIV infection.
- A dietician or nutritional counselor should educate the mother or caregiver.
- A social worker should interview the mother or caregiver and assist where help is needed.
- If the child is still not improving, refer to a paediatrician.
Important medical problems such as malabsorption, hypothyroidism, diabetes, urinary tract infection and chronic heart disease must be excluded.