Malnutrition in children under 5 causes irreversible damage to brain development, immune function, and growth. Early recognition allows intervention before permanent harm occurs.
Know the signs of malnutrition. Moderate acute malnutrition: visibly thin with prominent ribs and shoulder bones, upper arm muscle wasting, child is weak and inactive. Severe acute malnutrition: severely wasted with skin hanging loosely, OR severe bilateral leg oedema (swelling of both feet and legs), OR both.
Measure the mid-upper arm circumference (MUAC) if a tape is available. Measure halfway between the shoulder tip and elbow of the left arm, with arm hanging relaxed. Above 12.5cm — normal. 11.5 to 12.5cm — moderate malnutrition. Below 11.5cm — severe malnutrition, requires hospital treatment.
Check for bilateral pitting oedema: press with a thumb on the top of both feet for 3 seconds. If an indent remains on both feet, this is kwashiorkor — protein deficiency malnutrition.
Assess feeding: is the child breastfeeding? What foods is the child eating? How many times per day? Dietary history identifies the cause.
For mild to moderate malnutrition: increase feeding frequency and energy density. Add groundnut paste, oil, or egg to porridge. Continue breastfeeding.
Ready-to-use therapeutic food (RUTF) such as Plumpy'Nut is the most effective community treatment for moderate malnutrition — available through health centres and NGOs.
Treat associated infections. Malnourished children have impaired immunity and frequently have infections that must be treated alongside nutritional rehabilitation.
Stimulation and play are important alongside feeding — malnourished children are often developmentally delayed and need active engagement.
Monitor weight weekly if possible.
MUAC below 11.5cm.
Bilateral pitting oedema in both feet.
Child is not responding to stimulation or is unconscious.
Severe wasting visible — ribs, hip bones, and shoulder blades very prominent.
Associated fever, fast breathing, or severe diarrhoea.
Child is refusing all food and fluids.
Do not give full-fat cow milk alone as the primary treatment — it can cause complications in severely malnourished children.
Do not try to rehabilitate a severely malnourished child entirely at home — severe malnutrition with complications needs hospital care.
Do not overfeed a severely malnourished child rapidly — refeeding syndrome is dangerous.
Malnutrition is not just about food — infections, poor sanitation, and inadequate breastfeeding are key drivers.
✓ What Helps
· Ready-to-use therapeutic food (RUTF) — Plumpy'Nut or equivalent, available through NGOs and health programmes
· Multiple micronutrient supplements for children
· ORS for associated dehydration
✗ What To Avoid
· Forcing large amounts of food on a severely malnourished child
· Giving only carbohydrates without protein and fat
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· Community-based management of acute malnutrition programmes at the nearest health centre
· RUTF therapeutic food through nutrition programmes
· Vitamin A supplementation and deworming at health centre
🏥 Get Professional Help
Go to hospital or a nutrition programme immediately for any child with MUAC below 11.5cm, swelling of both feet, visible severe wasting, or a child who refuses all food. Severe malnutrition is a medical emergency.
How do I know if my child is malnourished?
Look for visible wasting of muscles especially in the arms and buttocks, a swollen belly with thin limbs, swelling of both feet, or hair that has become thin, dry and changed colour. Measuring the upper arm with a tape measure is the most accurate home assessment.
My child is thin but active and eating — is that malnutrition?
Not necessarily. Some children are naturally lean. Malnutrition is indicated by muscle wasting, weakness, developmental delay, frequent illness, and poor growth over time — not thinness alone.