Management of Chronic Malnutrition in 1-Year-Old Children

Classification Criteria and Appropriate Program

The World Health Organization recommends that a child with severe acute malnutrition requires a therapeutic feeding program (TFP) with a weight-for-height Z-score less than -3 or bilateral edema with fovea 1, 2
The American Academy of Pediatrics suggests that a child with moderate acute malnutrition requires a supplemental feeding program (SFP) with a weight-for-height Z-score between -2 and -3 or a mid-upper arm circumference of 115-135 mm 3, 4

The Centers for Disease Control and Prevention recommend providing 150 kcal per kg of body weight per day for children with severe acute malnutrition 1, 2
The World Health Organization suggests providing 3 grams of protein per kg of body weight per day for children with severe acute malnutrition 1, 2
The therapeutic feeding program should be divided into 4-6 small meals per day to maximize absorption 1, 2

The World Health Organization recommends administering a full course of vitamin A at admission to the program: 100,000 IU for children under 12 months 6, 2
The Centers for Disease Control and Prevention suggest repeating vitamin A supplementation every 3 months while in the program 4, 1
The American Academy of Pediatrics recommends providing iron syrup if iron deficiency anemia is highly prevalent, with a therapeutic dose of 3 mg/kg/day of elemental iron (ferrous sulfate) between meals 4, 7

The World Health Organization recommends administering amoxicillin as first-line therapy for uncomplicated severe acute malnutrition 2
The Centers for Disease Control and Prevention suggest that antibiotics reduce mortality and improve nutritional recovery 2

The World Health Organization recommends weighing children daily at first, then twice a week once stabilized, with a target weight gain of 10 grams per kg of body weight per day 1, 2
The American Academy of Pediatrics suggests that children can be discharged from the therapeutic feeding program to the supplemental feeding program when they have maintained 80% weight-for-height (or Z-score of -2) for a period of 2 weeks 1, 2

The World Health Organization recommends promoting exclusive breastfeeding when possible, and using iron-fortified infant formula as a substitute if breastfeeding is insufficient 8
The Centers for Disease Control and Prevention suggest avoiding the introduction of cow's milk before 12 months of age 8
The American Academy of Pediatrics recommends against distributing bottles and formula, and discouraging bottle-feeding 5