Nutrition and growth

Why it is important?

More than one third of all child deaths every year around the world are attributed to malnutrition, specifically under nutrition, which weakens the body's resistance to illness.

• If a woman is malnourished during pregnancy or if her child is malnourished during the first two years of life, the child's physical and mental growth and development will be slowed. This cannot be corrected when the child is older – it will affect the child for the rest of his or her life.
• Malnutrition develops when the body does not get the proper amount of energy (calories), proteins, carbohydrates, fats, vitamins, minerals and other nutrients required to keep the organs and tissues healthy and functioning well. A child or adult can be malnourished by being undernourished or over nourished.
• In most parts of the world malnutrition occurs when people are undernourished. Primary reasons for undernourishment, especially of children and women, are poverty, lack of food, repeated illnesses, inappropriate feeding practices, lack of care and poor hygiene. Undernourishment raises the risk of malnutrition. The risk is greatest in the first two years of life. The risk further increases when diarrhoea and other illnesses sap the body of the proteins, minerals and nutrients required to stay healthy.
• When a household does not have enough food and has conditions that make diarrhoea and other illnesses common, children are the most vulnerable to becoming malnourished. When children become sick, they lose energy and nutrients quickly, which puts their lives at risk faster than adults.
• Over nutrition is when a person is overweight or obese. It can cause diabetes in childhood and cardiovascular disease and other diseases in adulthood. Sometimes children eat large quantities of foods that are high in energy but not rich in other necessary nutrients, such as sugary drinks or fried, starchy foods. In such cases improving the quality of the child's diet is crucial along with increasing his or her level of physical activity.
• Children with chronic diseases, such as HIV, are even more susceptible to malnutrition. Their bodies have a harder time absorbing vitamins, iron and other nutrients. Children with disabilities may need extra attention to make sure they get the nutrition they need.
• All girls and boys have the right to a caring and protective environment, with mothers, fathers or other caregivers making sure they are well nourished with a healthy diet

What every family and community has a right to know?

1. A young child should grow and gain weight rapidly. From birth to age 2, children should be weighed regularly to assess growth. If regular weighing shows that the child is not gaining weight, or the parents or other caregivers see the child is not growing, something is wrong. The child needs to be seen by a trained health worker.
2. Breast milk alone is the only food and drink an infant needs in the first six months of life. After six months, a baby needs a variety of other foods in addition to breast milk to ensure healthy growth and development.
3. From the age of 6–8 months a child needs to eat two to three times per day and three to four times per day starting at 9 months – in addition to breastfeeding. Depending on the child's appetite, one or two nutritious snacks, such as fruit or bread with nut paste, may be needed between meals. The baby should be fed small amounts of food that steadily increase in variety and quantity as he or she grows.
4. Feeding times are periods of learning, love and interaction, which promote physical, social and emotional growth and development. The parent or other caregiver should talk to children during feeding, and treat and feed girls and boys equally and patiently.
5. Children need vitamin A to help resist illness, protect their eyesight and reduce the risk of death. Vitamin A can be found in many fruits and vegetables, red palm oil, eggs, dairy products, liver, fish, meat, fortified foods and breast milk. In areas where vitamin A deficiency is common, high-dose vitamin A supplements can also be given every four to six months to children aged 6 months to 5 years.
6. Children need iron-rich foods to protect their physical and mental abilities and to prevent anaemia. The best sources of iron are animal sources, such as liver, lean meats and fish. Other good sources are iron-fortified foods and iron supplements.
7. Iodine in a pregnant woman's and young child's diet is especially critical for the development of the child's brain. It is essential to help prevent learning disabilities and delayed development. Using iodized salt instead of ordinary salt provides pregnant women and their children with as much iodine as they need.
8. As the child's intake of foods and drinks increases, the risk of diarrhoea substantially increases. Contamination of foods with germs is a major cause of diarrhoea and other illnesses that cause children to lose nutrients and energy needed for growth and development. Good hygiene, safe water and proper handling, preparation and storing of foods are crucial to prevent illnesses.
9. During an illness, children need additional fluids and encouragement to eat regular meals, and breastfeeding infants need to breastfeed more often. After an illness, children need to be offered more food than usual to replenish the energy and nourishment lost due to the illness.
10. Very thin and/or swollen children need special medical care. They should be taken to a trained health worker or health facility for assessment and treatment.

Supporting Information

Key Messages - A young child should grow and gain weight rapidly. From birth to age 2, children should be weighed regularly to assess growth. If regular weighing shows that the child is not gaining weight, or the parents or other caregivers see the child is not growing, something is wrong. The child needs to be seen by a trained health worker.

Weight gain is the most important sign that a child is healthy and is growing and developing well. From birth to 1 year of age, infants should be weighed at least once every month. From 1–2 years of age they should be weighed at least once every three months.

Whenever a child visits a health centre, he or she should be weighed. This can help early detection of faltering growth so appropriate actions can be taken.

A health check-up can also detect if a child is gaining weight too fast for his or her age. This requires examining a child's weight in relation to his or her height, which can determine if the child is overweight.

If the child is underweight or overweight, it is important to examine the child's diet and provide the parents or other caregiver with advice on good nutrition. Increasingly there are undernourished and over nourished people side by side in a family.

A child who is given only breast milk for the first six months usually grows well during this time. Breastfeeding helps protect babies from common illnesses and ensures good physical and mental growth and development. Infants who are breastfed tend to learn more readily than infants who are fed other kinds of milk.

From the age of 6 months, a child needs to start eating a variety of other nutritious foods, in addition to breast milk, to ensure healthy growth and development.

Every child should have a growth chart that tracks his or her growth. It shows whether the child is growing appropriately for his or her age. At each weighing the child's weight should be marked with a dot on the growth chart and the dots should be connected. This will produce a line that shows how well the child is growing. If the line goes up, the child is doing well. A line that stays flat or goes down is a cause for concern.

Children need to gain not only adequate weight but also adequate height. A child's height can also be tracked on a chart. Good nutrition, care and hygiene, especially in the first two years of life, are necessary to prevent children from becoming too short for their age (stunted). If a mother is undernourished or does not have proper nutrition during pregnancy, her child may be born too small. This puts the child at risk of becoming stunted later on. A low-birth weight baby needs additional attention to feeding and care to grow adequately.

A child who is not gaining enough weight over one or two months may need larger servings, more nutritious food or more frequent meals. The child may be sick or may need more attention and care or assistance with eating. Parents and trained health workers need to act quickly to discover the cause of the problem and take steps to correct it.

Here are some important questions to ask to help identify growth problems:

• Is the child eating often enough? In addition to breastfeeding, a child aged 6–8 months needs to eat two to three times per day and three to four times per day starting at 9 months. Additional nutritious snacks, such as a piece of fruit or bread with nut paste, may be needed one or two times per day. A child with developmental delays or disabilities may require extra help and time for feeding.
• Is the child receiving enough food? A child aged 6–8 months needs to receive initially 2–3 spoonfuls of food, increasing gradually to 1/2 cup (250-millilitre), at each meal. A child 9–12 months old needs to receive 1/2 cup at each meal. A child 12–23 months old requires 3/4 to 1 whole cup of 'family foods' at each meal. Children 2 years and older need to receive at least 1 whole cup at each meal. If the child finishes his or her food and wants more, the child needs to be offered more.
• Do the child's meals have too little 'growth' or 'energy' foods? Foods that help children grow are beans, nuts, meat, fish, eggs, dairy products, grains and pulses. The daily inclusion of animal-source foods in the diet is particularly important. A small amount of oil can add energy. Red palm oil or other vitamin-enriched edible oils are good sources of energy. High-quality 'growth' foods are especially important to ensure that children gain both adequate weight and height. Foods such as highly processed fatty foods or sugary snacks are not rich in vitamins and minerals and other important nutrients and may cause children to gain too much weight without a proportionate growth in height.
• Is the child refusing to eat? If the child does not seem to like the taste of a particular food, other foods should be offered. New foods should be introduced gradually.
• Is the child sick? A sick child needs encouragement to eat small, frequent meals. The child needs to be breastfed more frequently. After an illness, the child needs to eat more than usual to regain the weight lost and to replenish energy and nourishment. If the child is frequently ill, he or she should be checked by a trained health worker.
• Is the child getting enough foods with vitamin A? Breast milk is rich in vitamin A. Other foods with vitamin A are liver, eggs, dairy products, red palm oil, yellow and orange fruits and vegetables, and green leafy vegetables. If these foods are not available in adequate amounts, a healthcare provider can provide the child with a vitamin A supplement (tablet or syrup) every four to six months.
• Is the child being given breast milk substitutes by bottle? If a breast milk substitute is given, it should be fed from a clean, open cup, rather than from a bottle.
• Is the food kept clean? If not, the child will often be ill. Raw food should be washed or cooked with clean water from a safe source. Cooked food should be eaten without delay. Leftover food should be carefully stored and thoroughly reheated.
• Is the water kept clean? Clean water is vital for a child's health. Water should come from a safe source and be kept clean by storing it in covered containers that are clean on the inside and outside. Clean drinking water can be obtained from a regularly maintained, controlled and chlorinated piped supply, public standpipe, borehole, protected dug well, protected spring or rainwater collection. If water is drawn from ponds, streams, unprotected springs, wells or tanks, it needs to be purified. Home water treatments can be used such as boiling, filtering, adding chlorine or disinfecting with sunlight in accordance with information provided by a trained health worker or extension agent.
• Are faeces being put in a latrine or toilet or buried? Are hands being washed with soap and water or a substitute, such as ash and water, after use of the latrine or toilet? If not, the child may frequently get worms and other sicknesses. A child with worms needs deworming medicine from a trained health worker.
• Is the young child left alone much of the time or in the care of an older child? If so, the young child may need more attention and interaction from adults, especially during mealtime.

Key Messages - Breastmilk alone is the only food and drink an infant needs in the first six months of life. After six months, a baby needs a variety of other foods in addition to breastmilk to ensure healthy growth and development.

In the first six months, when a baby is most at risk, exclusive breastfeeding helps to protect against diarrhoea and other common infections and gets the baby off to a good start in life.

At 6 months of age, the child needs other foods and drinks in addition to breastmilk. These provide energy, protein, vitamins and other nutrients needed to support growth and development.

A variety of foods – vegetables and fruits, meat, poultry, fish, eggs and dairy products – help to meet the child's nutrition needs. Breastfeeding for up to two years and beyond provides an important source of nutrients that protect against disease.

If soft, semi-solid or solid foods are introduced too late, the child may not be getting the necessary nutrients. This can slow down growth and development.

When introducing solid foods, it is important to start with soft, mushy foods and move gradually to more solid foods. The greater the variety of healthy foods, the more balanced and nutritious the child's diet.

The consistency and variety of foods should be adapted to a child's requirements and eating abilities. At 6 months of age infants can eat pureed or mashed foods, thick soups and porridges. By 8 months most infants can also eat 'finger foods' (snacks that children can eat by themselves). By 12 months, most children can eat the same types of foods as the rest of the family.

Parents or other caregivers should avoid giving foods that may cause choking, such as nuts, grapes and raw carrots and other foods that have a shape and/or consistency that may cause them to become lodged in the child's throat.

It may be difficult to meet all the child's nutrient requirements without a lot of foods from animal sources. So it may be necessary to give the child fortified foods or spreads or multiple vitamin and mineral supplements, such as powders, syrups or dissolvable tablets. A trained health worker can advise the parent or other caregiver about foods that provide the most nutrients and which supplements to use.

Following are some nutritious foods for young children (older than six months) to eat:

• Staple foods, including cereals (rice, wheat, maize, millet, quinoa), roots (cassava, yam, potatoes) and starchy fruits (plantain and breadfruit).
• High-protein foods, such as red meat, poultry, fish, liver and eggs (can be given as often as possible).
• Dairy products, such as cheese, yogurt, curds and dried milk (which can be mixed with other foods, such as cooked porridge). These are good choices in the second six months of a breastfed child's life. These are better choices than raw milk, which is harder for the child to digest.
• Green leafy and orange-coloured vegetables, such as spinach, broccoli, chard, carrots, pumpkins and sweet potatoes (which provide vitamins).
• Pulses, such as chickpeas, lentils, cowpeas, black-eyed peas, kidney beans and lima beans (to add variety and provide protein, energy and some iron).
• Oils, especially rapeseed oil, soy oil, red palm oil, butter or margarine.
• Seeds, including groundnut paste, other nut pastes and soaked or germinated seeds, such as pumpkin, sunflower, melon or sesame seeds (for energy and some vitamins).

It is difficult to provide all the nutrients needed by young children in a vegetarian diet. This is because foods from animal sources provide key nutrients, such as iron. A child eating a vegetarian diet needs additional nutrients in the form of multiple vitamin tablets or powders, fortified spreads or nutrient-rich food supplements.

Iron from plant foods is generally not absorbed very well by the body. However, plant foods such as pulses (white beans, chickpeas, lentils) have more iron. The iron will be better absorbed if eaten together with foods that are high in vitamin C, such as oranges and other citrus fruits and juices.

Key Messages - From the age of 6–8 months a child needs to eat two to three times per day and three to four times per day starting at 9 months, in addition to breastfeeding.

Good nutrition in the first two years of life is crucial. Inadequate nutrition during this period can slow a child's physical and mental development for the rest of his or her life.

In order to grow and stay healthy, young children need a variety of nutritious foods such as meat, fish, pulses, grains, eggs, fruits and vegetables, as well as breastmilk.

A child's stomach is smaller than an adult's, so a child cannot eat as much at one meal. However, children's energy and body-building needs are great. It is important that children eat frequently to provide for all their needs.

Foods such as mashed vegetables and chopped meat, eggs or fish should be added to the child's diet as often as possible. A small amount of oil may be added, preferably vitamin-enriched oil.

If meals are served in a common dish, younger children may not get enough food. Giving a young child his or her own plate or bowl makes it easier for the parent or other caregiver to know what foods and how much the child has eaten.

Young children may need to be encouraged to eat, and they may need help in handling food or utensils. A child with a developmental delay or disability may need extra help eating and drinking.

The following gives information on how often and how much a young child should be fed:

6–8 months:

Children should breastfeed frequently and receive other foods two to three times a day. Parents should start with soft or mushy foods (such as porridge) and gradually increase the consistency (thickness) of food. Animal foods such as meat, eggs and fish can be given as early as possible, but they should be mashed, minced or cut into very small pieces. Start with 2–3 spoonfuls per feeding, increasing gradually to 1/2 of a 250-millilitre cup.

9–24 months:

Children should receive other foods three to four times a day in addition to breastfeeding. Give infants aged 9–11 months 1/2 of a 250-millilitre cup per feeding. Provide children aged 12–23 months 3/4 to 1 whole 250-millilitre cup per feeding. Give children 2 years and older at least 1 whole 250-millilitre cup per feeding. Foods from animals, such as meat, fish and eggs, should be included as much as possible.

By 12 months:

Most children are able to consume 'family foods' of a solid consistency. They can still be offered semi-solid foods, which are easier for young children to eat. Additional nutritious snacks (such as fruit, bread or bread with nut paste) can be offered once or twice per day, as desired, starting at six months. If the quality or amount of food per meal is low, or the child is no longer breastfeeding, give 1–2 cups of milk plus one or two extra meals each day.

Key Messages - Feeding times are periods of learning, love and interaction, which promote physical, social and emotional growth and development. The parent or other caregiver should talk to children during feeding, and treat and feed girls and boys equally and patiently.

• Mealtimes provide the opportunity for mothers and fathers or other caregivers to interact and talk with children and support their learning. This helps to stimulate social and emotional development.
• It is important to encourage children to eat, but not to force-feed them. Each child's needs vary due to differences in breastmilk intake and variability in growth rate. Infants need to be fed directly. Young children should be assisted when they are learning to feed themselves.
• If a child refuses to eat a variety of foods, the caregiver can experiment with different food combinations, tastes, textures and methods of encouragement. The caregiver should minimize distractions during meals if the child loses interest easily.
• Girls and boys require the same amount of attention and time for feeding. They should receive the same quantity and quality of food and drink. They both need to be breastfed for the first six months and receive an adequate variety and quantity of foods after six months. It is important for both mothers and fathers to be informed about child nutrition. Both parents should take part in feeding their daughters and sons.

Key Messages - Children need vitamin A to help resist illness, protect their eyesight and reduce the risk of death. Vitamin A can be found in many fruits and vegetables, red palm oil, eggs, dairy products, liver, fish, meat, fortified foods and breastmilk.

• Until infants are 6 months old, breastmilk is the main source of vitamin A, provided the mother has enough vitamin A from her diet or supplements. Children aged 6 months to 5 years can get vitamin A from a variety of other foods, such as liver, eggs, dairy products, fatty fish, red palm oil, ripe mangoes and papayas, oranges, yellow sweet potatoes, dark green leafy vegetables and carrots.
• When children do not have enough vitamin A they are less able to fight potentially fatal diseases and are at risk of night blindness. A child who has difficulty seeing in the early evening and at night is probably deficient in vitamin A. The child should be taken to a trained health worker for treatment with high-dose vitamin A supplements.
• In a few countries, vitamin A has been added to cooking oils, sugar, wheat and flours, milk and dairy products, and other foods. In many countries where vitamin A deficiency is widespread and children often die from illnesses such as diarrhoea and measles, vitamin A is distributed twice a year to children 6 months to 5 years of age in a high-dose capsule or syrup.
• Diarrhoea and measles deplete vitamin A from the child's body. A child with diarrhoea lasting several days or with measles, or who is severely malnourished, should be treated with high-dose vitamin A supplements obtained from a trained health worker.
• In areas where it is known or suspected that children suffer from vitamin A deficiency, those children with diarrhoea should be given a vitamin A supplement if they have not received one within the past month, or if they are not already receiving vitamin A at regular four to six month intervals.
• Children with measles should receive vitamin A on the day of diagnosis, a dose on the following day and another dose at least two weeks later.
• Zinc (tablet or syrup) can also be given for 10–14 days to reduce the severity and the duration of the diarrhoea as well as protect the child for up to two months from future diarrhoea episodes. The dosage for children over 6 months of age is 20 milligrams per day, for children under 6 months of age it is 10 milligrams per day.

Key Messages - Children need iron-rich foods to protect their physical and mental abilities and to prevent anaemia. The best sources of iron are animal sources, such as liver, lean meats and fish. Other good sources are iron-fortified foods and iron supplements.

A lack of iron in the diet is a common cause of anaemia. Children can also become anaemic from malaria and hookworm. Iron deficiency can impair physical and mental development in infants and young children. Even mild iron deficiency can impair intellectual development. Anaemia is the most common nutritional disorder in the world.

Iron is found in animal foods such as liver, lean meats and fish. It is also in some vegetarian foods such as pulses. Foods such as wheat and maize flours, salt, fish sauce or soy sauce are sometimes fortified with iron. Iron-rich foods help prevent anaemia. Consuming them with vitamin C helps the digestive system to better absorb the iron.

Symptoms of anaemia include paleness of the palms of the hands and of the tongue and inside the eyelids and lips as well as tiredness and breathlessness.

In children under 2 years of age:

• Anaemia may cause problems with coordination and balance, and the child may appear withdrawn and hesitant. This can limit the child's ability to interact and may hinder intellectual development. The child can benefit from iron-containing vitamin and mineral preparations, such as supplements and multiple vitamin and mineral powders. These powders can be easily mixed by the caregiver in homeprepared foods for children older than 6 months.

In pregnant women and adolescent girls:

• Anaemia increases the severity of haemorrhage and the risk of infection during childbirth. It is an important cause of maternal mortality. Infants born to anaemic mothers often suffer from low birthweight and anaemia. Iron supplements for pregnant women protect both the mothers and their babies. Adolescent girls who are anaemic will also benefit from a weekly iron-folic acid supplement to build their iron stores and prepare their bodies for healthy pregnancies.
• Malaria and hookworm can be main causes of anaemia. Taking iron supplements to treat anaemia while having malaria can worsen the anaemia.

With regard to malaria:

• Children living in malarial areas should not take iron and folic acid preparations, including iron-containing powders, unless the malaria has been diagnosed and treated and they have been screened for anaemia.
• In general, children living in malarial areas should not be given preventive doses of iron-containing vitamin and mineral preparations or supplements unless they are delivered through a fortified food.
• Pregnant women, mothers, fathers and other caregivers living in malarial areas need to ask a trained health worker about using iron supplements for their children.
• To help prevent malaria, children, pregnant women, and mothers and other family members should sleep under insecticide-treated mosquito nets.

With regard to worms:

• Children living in areas where worms are highly endemic should be treated two to three times a year with a recommended deworming (anthelmintic) medication. Deworming the child regularly helps treat the anaemia caused by worms and also helps children regain their appetite. Good hygiene practices prevent worms. Children should not play near the latrine, should wash their hands often with soap and water or a substitute, such as ash and water, and should wear shoes or sandals to prevent worm infestations.
• Pregnant women living in areas where worms are common should be treated with a recommended deworming medication.

Key Messages - Iodine in a pregnant woman's and young child's diet is especially critical for the development of the child's brain. It is essential to help prevent learning disabilities and delayed development. Using iodized salt instead of ordinary salt provides pregnant women and their children with as much iodine as they need.

• Small amounts of iodine are essential for children's growth and development. If a woman does not have enough iodine during pregnancy, her child is likely to be born with a mental disability or possibly a hearing or speech disability. If the child does not get enough iodine during infancy and childhood, he or she may have delayed physical, mental or cognitive development. Even mild deficiency can reduce learning ability and lower intelligence.
• Goitre, an abnormal enlargement of the thyroid gland causing a swelling of the neck, is a sign of iodine missing in the diet. Iodine deficiency in early pregnancy increases the risk of miscarriage or stillbirth.
• Using iodized salt instead of ordinary salt provides pregnant women and children with as much iodine as they need. Iodized salt is safe for the whole family and is the only salt needed for all cooking. Families should be sure to buy only iodized salt of good quality – properly marked and packaged. Mothers need to make sure they consume only iodized salt before, during and after pregnancy. Mothers and fathers need to ensure that the salt consumed by their children is iodized.

Key Messages - As the child's intake of foods and drinks increases, the risk of diarrhoea substantially increases. Contamination of foods with germs is a major cause of diarrhoea and other illnesses that cause children to lose nutrients and energy needed for growth and development

• As children grow and become mobile they put everything in their mouths. They can pick up germs more easily as they explore and discover the world around them. This makes it very important for parents and other caregivers to practice good hygiene, such as hand washing with soap. They also need to handle and prepare food properly, use safe water and keep the living environment clean. These practices are important to prevent diarrhoea and other illnesses and to protect a child's health.
• Foods should be served immediately after preparation and leftovers safely stored. Clean utensils and surfaces should be used to prepare and serve food. Children should be fed with clean cups and bowls. Bottles and nipples/teats should be avoided because they are difficult to keep clean.
• Five key ways to keep food safe are: keep it clean; separate raw and cooked foods; cook food thoroughly; keep it at a safe temperature; and wash raw food materials in safe water.

Key Messages - During an illness, children need additional fluids and encouragement to eat regular meals, and breastfeeding infants need to breastfeed more often. After an illness, children need to be offered more food than usual to replenish the energy and nourishment lost due to the illness.

• When children are sick, such as when they have diarrhoea, measles or pneumonia, their appetite decreases and their body uses food less effectively. If the child is sick several times a year, his or her growth will slow or stop.
• It is very important to encourage a sick child to eat. This can be difficult, as children who are ill may not be hungry. The parent or other caregiver should keep offering foods the child likes, a little at a time and as often as possible. Extra breastfeeding is especially important since it can provide nutrients required for recovery from infections.
• It is essential to encourage a sick child to drink as often as possible. Dehydration (lack of fluids in the body) is a serious problem for children with diarrhoea. Drinking plenty of liquids will help prevent dehydration. When a child has diarrhoea, giving him or her oral rehydration salts (ORS) dissolved in clean water, along with foods and liquids, can help prevent dehydration. Giving the child a zinc supplement every day for 10–14 days can reduce the severity of the diarrhoea. The child is not fully recovered from an illness until he or she weighs about as much as when the illness began.
• A child can die from persistent diarrhoea if it is not treated quickly. If diarrhoea and poor appetite persist for more than a few days, the mother, father or other caregiver needs to consult a trained health worker.

Key Messages - Very thin and/or swollen children need special medical care. They should be taken to a trained health worker or health facility for assessment and treatment.

• A short period of inadequate nutrition together with illness or infection can quickly make a child dangerously malnourished. The child needs urgent treatment with special foods and medicine. He or she should be taken directly to the nearest health-care provider.
• Children with severe acute malnutrition are very thin. They may also have swollen parts of the body, usually the feet and the legs. A trained health worker can identify severe acute malnutrition by measuring the child's weight and height, using a special band to measure the upper arms or checking for equal swelling in both legs.
• Treating a child with severe acute malnutrition effectively needs to be done by a health-care provider. The treatment depends on how sick the child is. Most children over 6 months old can be treated with a special ready-to-use therapeutic food (RUTF). This is a soft pre-packaged food that contains all the nutrients needed for the child's recovery. RUTF is easy for children to consume directly from the packet and requires no mixing with water or other foods, making it safe to use anywhere. Parents or other caregivers are provided with a week's supply of RUTF, along with information on how to treat the child. Medications are also provided as part of the treatment. The child should be taken back to the health-care provider every week to monitor his or her progress.
• More intensive treatment is needed for children who are not able to eat RUTF, have other medical problems or are under 6 months old. These cases should be referred to a hospital or other facility that can provide 24-hour medical care, therapeutic milks and breastfeeding support.
• Children with severe acute malnutrition get cold more quickly than other children, so they must always be kept warm. Skin-to-skin contact with the mother or other caregiver can help keep a child warm. Both the mother and child should be covered. The child's head should also be kept covered.
• Although children with severe acute malnutrition need special nutritional treatment, breast milk is still a vital source of nutrients and protection from disease. In addition to the special treatment (either at home or in a facility), children who are breastfeeding should continue to breastfeed .

Source: UNICEF