Serial weight and height measurement and recording on the growth chart should be done as part of the Maternal and Child Health (MCH) programme. All children have their own individual growth curve, but if they deviate from the curve the
reason should be investigated.

Growth monitoring after 9 months is generally inadequate as parents and health care providers tend to associate clinic attendance with immunization. So after the  measles vaccine at 9 months few mothers see the need to come to clinic unless
the child is unwell. Also as the child grows bigger and maybe the mother has a new baby, the older child is no longer priority. Growth monitoring at community level has been in existence for a long time , but is probably not widespread.

It is necessary to make growth monitoring an important community activity. Growth monitoring is important throughout childhood to detect not only failure to grow well but also features of over-nutrition like obesity Poor growth is detected
by the regular use of the growth chart. As soon as a slowing growth is detected action must be taken. The advice given to a mother depends on the age of the child. The advice must be practical and the mother must be able to do what she
is told.

The community health workers can be trained and supported to do this. They together with the parents need to visualize the growth of children and seek help if the child is not growing appropriately. All children up to age 5 years should be
weighed regularly – preferably monthly weighing up to 5 years. To do this they need weighing scales and tools for length/height measurement. Currently, charts are readily available only for children up to 5 years.

When a Child Does Not Grow Well: Assess Nutritional Status

The following classifications are important for parents to know about their
children to assist them to avoid malnutrition:

Classification Signs
Normal No low weight for age and no other signs of malnutrition
Very low weight Very low weight for age
Poor weight gain/td
Severe malnutrition Visible severe wasting, baggy pants sign
Oedema of both feet

When a child does not grow well:

  • Assess the child’s feeding.
  • Ask what the child is fed on.
  • Ask how many times the child is fed in a day.
  • Counsel the mother on feeding against the child’s growth chart, and discuss with the mother about any
    necessary changes.

Follow up programme for child:

  • Review the progress of the child in 5 days.
  • Re-assess feeding.
  • Counsel mother about any new or continuing feeding problems.
  • If child is very low weight for age, ask the mother to return 14 days after the initial visit to monitor the child’s weight.
  • Encourage the mother to continue the feeding programme until the child gains appropriate weight for age if after 14 days the child is no longer very low

Feeding recommendations children with poor growth or lack
of growth

Age Growth chart shows Recommendations
0–6 months Poor or no weight gain for 1 month Breastfeed as many times as possible, day and
night. Check that mother is breastfeeding properly
and that her diet is adequate.
Poor or no weight
gain for 2 months
As above. In addition, the mother should be
encouraged to eat and drink enough. Refer child
for investigation. Child may have hidden illness.
7–12 months Poor or no weight gain Breastfeed as often as child wants. Give adequate
servings of enriched complementary feed at least
3 times a day if breastfed and 5 times if not
13–24 months No/poor weight gain
for 1 month
Continue breastfeeding. Check diet composition
and how much child takes. Advise on how to
enrich the food. Feed 3 main meals. Give snacks
at least 2 times between meals.
Poor or no weight
gain for 2 months
Continue feeding as above. Take history and
24 months
and over
Poor or no weight
Child should eat half as much food as the father.
Child should be encouraged to eat with other
children, but should have an adequate serving of food served separately. Take history and refer.

weight for age. And then advise her to maintain feeding the child an adequate
nutritious, well balanced diet.

Refer all children for further evaluation if:

  • Weight has not increased in the last 2 months even though the mother/ caregiver says they are following the advice on feeding practices.
  • Sick children are not gaining weight adequately. (Sick children may need to be referred immediately for other reasons).
  • Child continues to lose weight (consider TB, HIV infection among other problems).
  • Child’s weight is well below the bottom line on the chart.
  • Child has any sign of swelling of the feet and face (Kwashiorkor) or severe wasting (marasmus).

Advice to mothers should be:

  • Well babies less than 6 months old need no other milk or food apart from breast milk.
  • Adding oil, margarine, or sugar, and milk, egg, or mashed groundnuts makes uji and other foods energy rich and helps young children grow well.
  • Feed often – like 5 times a day: small children have small stomachs.
  • Feed older children at least 5 times a day.
  • Feed sick children at least one extra meal per day and continue for 1–2 weeks after they recover.
  • Continue to take interest in what the child feeds on even in the school years.
  • Mothers should know that the children are likely to have poor school performance if not fed well.
  • Avoid over feeding and limit non nutritious snacks, especially if the child is overweight.