What is the management of an underweight-for-age child?

  1. A careful history, physical examination and review of the weight and height (and head circumference in infants) growth curves is essential to establish the pattern of growth and the underlying cause of the failure to thrive. Treat any medical problem.
  2. The child should be given a normal, well-balanced diet (a trial of feeding) if malnutrition is diagnosed. Frequent small feeds increase the total food intake and should be given at least 5 times per day. Peanut butter, vegetable oil or sugar added to the staple diet can be used to increase energy intake. Cheap forms of protein (milk powder, peas, beans) must be encouraged. Food supplements are available at clinics and hospitals under the state’s nutrition programme for qualifying families.
  3. The child must be closely followed for 2 weeks. If there is no weight gain, the child must be admitted to hospital for a controlled trial of feeding and possibly further investigation.
  4. If there is weight gain, the child must be carefully followed with repeat weight checks to ensure that weight gain continues. Height will only be gained after a few months of satisfactory weight gain.
  5. The underlying cause of the poor feeding must be addressed or the problem will simply recur. Nutritional education of the mother is essential. Financial aid may be needed.
  6. It is best to deworm the child and give vitamin A according to the national vitamin A policy as many underweight for age children have worms and are likely to have mild vitamin A deficiency. Multivitamin syrup is needed during the phase of catch-up growth and also if the usual diet is deficient in fresh vegetables or fruit.
  7. Measure the haemoglobin concentration and treat anaemia with oral iron.

Good nutrition will correct growth in most children that are underweight.

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