Protocol for Identification and Management of Malnutrition in Children

October 11, 2023

In a significant development, a new ‘Protocol for Management of Malnutrition in Children’ was launched, bringing changes to the way severely malnourished children without medical complications are handled. This protocol, created by the Center, focuses on streamlining the management of malnourished children at anganwadi centers.

Management at Anganwadi Centers

Under the new protocol, Severe Acute Malnourished (SAM) children without medical complications will be managed at anganwadi centers instead of Nutrition Rehabilitation Centers (NRCs). This marks a significant shift in the approach to handling malnutrition.

NRC Enrollment Criteria

SAM children with specific medical complications, bilateral pitting edema, or those who fail the appetite test will be enrolled in NRCs. Bilateral pitting edema refers to swelling in both legs or arms characterized by a persistent indentation when pressure is applied.

Expansion of NRC Services

Until now, NRCs primarily managed SAM children aged six to 59 months. However, with the new protocol, NRCs will extend their services to infants aged one to six months who are severely malnourished or at severe nutritional risk.

Health Screening for SAM and Severely Underweight Children

The protocol mandates that SAM children who pass the appetite test, along with all severely underweight (SUW) children, undergo health screening within three to five days of the test by a medical officer at primary health centers. This screening aims to identify any health issues, hidden infections, or danger signs.

Referral for Medical Complications

Children with any medical complications should be referred to the nearest health facility for medical management and further treatment of their illness.

Immediate Referral for Infants

According to the protocol, infants under six months of age who display visible signs of wasting, edema, or are too weak to suckle should be immediately referred to the nearest health facility or NRC for evaluation and treatment by ASHA/AWW/ANM.

Referral for Severely Underweight Children

Additionally, severely underweight children up to six months should be referred directly to NRCs for further management as per WHO guidelines.

Prevalence of Malnourished Children

Among over seven crore children evaluated at anganwadi centers, approximately seven percent were identified as severely acutely malnourished. This emphasizes the importance of the new protocol.

Mini-Anganwadi Centers Upgrades

It was also noted that 42,000 mini-anganwadi centers have been converted into anganwadi centers, and all equipment in these centers will be refurbished every four years to ensure the effectiveness of the program.

Identification of Malnourished Children

The protocol underscores the importance of identifying malnourished children through growth monitoring data, including weight-for-height and weight-for-age measurements. After the identification process, appetite tests will be carried out by the Anganwadi Workers (AWW) for all SAM children to assess the presence of medical complications.

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