Nutritional Status (Age 2 months up to 5 years)

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Look and Feel:

• Look for mouth ulcers. Are they deep and extensive?
• Weigh the child and plot the child’s weight-for-age in the RTHB
• Look at the shape of the child’s weight curve. Does it show weight loss, unsatisfactory weight gain or satisfactory weight gain?
• If the child is 6 months or older measure the child’s MUAC* and record in the child’s RTHB
• If the child’s weight-for-age chart shows a problem it is important to also measure and record their length/ height-for-age and weight-forlength/height in the child’s RTHB to check for stunting and wasting, respectively
• Look for oedema of both feet
• Conduct an Appetite Test if indicated

* MUAC is Mid-Upper Arm Circumference which should be measured in all children 6 months or older using a MUAC tape.
** Growth curve flattening/ decreasing is defined by changes on the growth curve over a 2-3 month period.

Classify all Children's Nutritional Status

Sever Acute Malnutrition With Medical Complication
One or more of the following Oedema of both feet Weight for length/ height Z-score less than - 3 OR MUAC less than 11.5 cm AND  One or more of the following: Any danger sign Any other RED or YELLOW classification Weighs 4 kg or less Less than six months of age If fails appetite test	Test for low blood sugar, then prevent  Keep the child warm  Give antibiotic. If indicated for another classification, give ceftriaxone. Otherwise give first dose of  amoxicillin  Give stabilizing feed or F75  Give dose of Vitamin A  Refer URGENTLY
Severe Acute Malnutrition Without Medical Complication
Weight for length/ Height Z-score < - 3  OR MUAC ≤ 11.5 cm  AND No oedema of both feet Six months or older Weighs 4 kg or more No other RED or YELLOW classification	Give amoxicillin for 5 days  Give dose of Vitamin A and treat for worms if due  Assess the child’s feeding and counsel the caregiver on the feeding recommendations Assess for possible HIV & TB infection  Provide RUTF or other supplements according to local guidelines  Advise caregiver when to return immediately  Make sure that the child has a birth certificate, and is receiving a child support grant if eligible. Refer to other available services if indicated (CHW, social worker, community based organisations) Follow up in 7 days
Moderate Acute Malnutrition
Weight for length/ height between -3 and –2 z-score OR MUAC from 11.5 cm to 12.5 cm No oedema of both feet	Give dose of Vitamin A and treat for worms if due Assess the child’s feeding and counsel the caregiver on the feeding recommendations Assess for possible HIV & TB infection  Provide RUTF or other supplements according to local guidelines  Advise caregiver when to return immediately  Make sure that the child has a birth certificate, and is receiving a child support grant if eligible. Refer to other available services if indicated (CHW, social worker, community based organisations) Follow up in 7 days
Not Growing Well
Losing weight OR Weight gain unsatisfactory OR Low or very low weight OR Low length for age (children below 24 months)	Assess the child’s feeding and counsel the caregiver on the feeding recommendations  Assess for possible HIV & TB infection  Treat for worms and give Vitamin A if due  Make sure that the child has a birth certificate, and is receiving a child support grant if eligible. Refer to other available services if indicated (CHW, social worker, community based organisations) Advise caregiver when to return immediately  If feeding problem follow up in 7 days  If no feeding problem, follow-up after 14 days
Overweight / Obese
Weight for length/ height greater than +2 z-score	Assess feeding, and counsel caregiver Provide dietary counseling  Encouraging healthy eating habits for entire family  Provide advice on physical activity
Growing Well
Weight normal AND Weight gain satisfactory AND Weight for length/ height –2 z-score or more OR MUAC 12..5 cm or more	Praise the caregiver If the child is less than 2 years old, assess feeding and counsel the caregiver on feeding according to the feeding recommendations  If feeding problem, follow up in 7 days

 

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Integrated Management of Childhood Illness 2022; Child (Age 2 months up to 5 years); Assess, Classify and Identify Treatment; Nutritional Status

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Last checked for updates: June 2023