Hesperian Health Guides

7. Low weight, slow growth, and malnutrion

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HealthWiki > Helping Children Live with HIV > Chapter 12: Common health problems > Low weight, slow growth, and malnutrion

Malnutrition means not getting enough food or enough of certain kinds of food. The main sign of malnutrition in babies and children is not growing well. Growing too slowly is a warning sign, of possible mild malnutrition. When growth stops or goes backward, the child is in danger, and may have severe malnutrition.

Mild malnutrition over many months can still be harmful, causing stunting, which is not gaining height like other children the same age. Many children with HIV are stunted.

Severe malnutrition, especially in children under 1 or 2 years old, can cause wasting, which means children become very thin because their bodies use their own muscles and stores of fat to stay alive. Malnutrition in children under 2 years old can cause serious physical and mental disabilities.

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wasted and stunted wasted stunted healthy

Children with HIV need more food than children who do not have HIV. If they do not get enough food, they do not grow well. They:

  • do not gain weight or height like other children their age.
  • are often thinner, smaller, weaker, and lack energy compared to other children their age. Sometimes this is called "failure to thrive."
  • are not able to fight illness well, so they die more easily from diseases such as diarrhea or pneumonia.
  • may also not develop mentally or emotionally as well as they should.

Even in a baby 3 or 4 months of age, you may see signs of slower growth and development if the baby has HIV and is not taking ART, such as staying very small, not gaining weight, and being too weak to breastfeed well.

To prevent malnutrition, measure growth

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This charts the growth of a child who needed more food. When she got it, she started growing again.

Weigh a baby every month or so for the first 2 or 3 years, and until at least age 5 if the child is small or not growing well. Health centers often weigh and measure your child each time you visit, and you can keep a record too.

If a child's weight stays the same for a couple of months, the child may need more food. And if he then gets more to eat, he may be able to catch up.

See Chapter 10 for information on feeding children. Use the recipes below to help children with HIV get extra nutrition.

Some children lack enough of certain vitamins or minerals. A child with pale palms may need more iron. A child with regular diarrhea may need vitamin A. These and other vitamins, such as vitamin B complex and folic acid, can be given to children who have signs of not enough of these in their diet.

All children grow faster at some times and slower at others, and this is OK. But a young child who stops growing for some time, or loses weight, or can no longer do things he had already learned to do, may be seriously ill. Do not wait long to seek help. See Chapter 3 for stages of development in young children.

The sooner children with HIV start ART, the better, stronger, and healthier they will grow.

How to make high-energy foods

Feed your child high-nutrition foods called “Ready to Use Foods – RUTFs” such as PlumpyNut. For a much lower cost than buying them, you can make these highly concentrated foods at home. Here is a simple recipe to follow that allows you to combine foods that are almost always available in local markets.

Combine 4 kinds of food using ingredients local to where you live: porridge, protein, fat or oil, and vegetables.

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Use whatever starchy food you usually make for your family, cooked into a thick paste (not a thin broth).
  1. Make 1 cup porridge from a starchy energy food.
    Choose any one of these:
    millet, maize, rice, wheat, cassava, yam or potato.
  2. Add a high protein food.
    Choose any one of these:
    • 2 tablespoons milk powder
    • 1 egg
    • ½ cup roasted, pounded, or ground seeds or nuts
    • ½ cup cooked, mashed beans, lentils, or peas
    • ½ cup cooked bean or pea flour
      HIV Ch12 Page 247-3.png
    • ½ cup dried, pounded fish
    • ¼ cup cooked, finely chopped meats or organ meats
    HIV Ch12 Page 247-4.png
  3. Add 2 tablespoons fat or oil:
    any vegetable or nut oil, ghee, or lard.
  4. HIV Ch12 Page 247-5.png
  5. Add ½ cup cooked vegetable.
    Choose any one of these:
    Tomato, green leafy vegetables, squash, pumpkin, green beans, fresh peas, okra, or other vegetable.

Give this high-energy porridge 4 or 5 times a day.

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A malnourished child may not want to eat or may have energy to eat only very slowly. Offer a little food every hour or two. Be patient and persistent. Keep feeding this high-energy food to the child until she begins to gain weight and get her energy, health, and spirit back.

Wash your hands before cooking or serving food, use clean dishes, and only make enough food for a day or so. Like any food, this high-energy food will eventually spoil, and will spoil faster if you live where it is hot.

If the child is still nursing, breastfeed first and then give high-energy food. Malnourished children may be too weak to nurse enough at each feed, so offer breast milk more often.

Also give fruit every day. Any fruit will give vitamins. But if you can, give different fruits on different days. That way, the child will get a variety of vitamins.

Treat children for worms

In communities where cleanliness and sanitation are difficult, all children (both with or without HIV) between 1 and 5 years old may benefit from regular deworming. This allows the nutrition in a child's food to go to him, and not to the worms. Because worms may be very small, deworm children even if you do not see worms in their stool.


Mebendazole: Dose by age:
1 to 2 years old: give 100 mg, once every 6 months.
2 to 5 years old: give 500 mg, once every 6 months.


Albendazole: Dose by age:
1 to 2 years old: give 200 mg, once every 6 months.
2 to 5 years old: give 400 mg, once every 6 months.

This page was updated:27 Nov 2019