A standardized national 'Protocol for Management of Malnourished Children (CMAM)' has been jointly developed by MoWCD and MoHFW. The protocol was launched on 10th October, 2023, with a focus of identifying, treating, and managing malnourished children both at Anganwadi Centres and in communities.
CMAM protocol helps in determining when to refer a malnourished child to Nutritional Rehabilitation Centre (NRC)/ medical facility. The protocol also outlines the steps for identification, management, referral, care level decision-making, nutritional and medical management, and follow-up at the Anganwadi level.
While malnutrition is widely used to describe under nutrition, it actually represents both under and over nutrition. While under-nutrition results from inadequate intake or poor absorption or excessive loss of nutrients, over-nutrition results from excessive energy and fat intake.
Three anthropometric indices, (i) weight-for-age, (ii) height/length-for- age, (iii) weight- for-height/ length are used to identify different forms of undernutrition, i.e. underweight, stunting and wasting respectively.
Undernutrition affects every stage of life, but its most severe consequences often occur during the first 1000 days, spanning from conception to the child's second birthday. The onset of underweight and stunting typically begins early, within these first two years, when proper and sufficient feeding is crucial and children are susceptible to frequent infections, especially diarrhoea.
Adopting a life-cycle approach, schemes like Mission Saksham Anganwadi and Poshan 2.0 and Pradhan Mantri Matru Vandana Yojana (PMMVY) have been designed to meet the nutritional requirements of pregnant women, lactating mothers, children and adolescent girls in country.
Presence or absence of good appetite in the child with Severe Acute Malnutrition is an important step on planning his/her treatment and rehabilitation ahead. Children who have good appetite and are able to eat adequate amount of food can be managed at home with the support of AWWs/ASHAs. Following steps are required to be done for Appetite test at Anganwadi center.
A. Do the Test in a separate quiet and comfortable aera where the child will be given up to an hour for eating the test diet.
B. Explain to the mother/caregiver how the test will be done.
C. The mother/caregiver should wash her hands.
D. The Mother sits comfortably with the child on her lap and offers feed.
E. The child should not have taken any food for the last 2 hours.
F. Child may be offered the test feed according to the body weight: <5kg-15 grams (3 teaspoon) Test feed, 5 to 9.9 kg-30 grams (6 teaspoon) Test feed; and > 10 kg-45 grams (9 teaspoon) Test feed. One teaspoon is roughly equivalent to 5grams.
G. When the child has finished the amount is judged or measured.
H. The child should have consumed most (at least three fourth) of the test feed offered as per weight to pass the test.
I. Following the appetite test the child should be observed for 30 minutes for any immediate adverse events.
Child who refuse to eat optimally are required to be referred to Nutrition Rehabilitation Centre (NRC).
| Name | Landline | |
|---|---|---|
| Ms. Arkaja Das | arkaja[dot]das[at]gov[dot]in | 011-23385192 |
