Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694834571613.pdf (India)
What to feed a child (0-5 years)?

How to enhance nutritive value of meal for children?
Amount (for breastfed child) Frequency Texture of food Examples Soft mashed food items Finger foods which child can pick herself and eat Finger foods which child can pick herself and eat Properly mashed fruits and vegetables; soft dalia Long cut pieces of fruits and pieces of chapatti Long cut pieces of fruits and pieces of chapatti Child can enjoy all different textures of food Rice/chapatti, pulses, vegetables, seasonal fruits, milk & milk products and animal foods (egg, fish, and meat).
B A L A M R U T H A M + Age 6 - 8 months 9 - 11 months 12 - 24 months Start with 2-3 table spoons per feed and gradually increase to ½ cup of a 25o ml cup or bowl along with breastfeeding 2-3 meals per day plus breastfeeding ½ of 250 ml cup or bowl and gradually increase to ¾ cups or bowl along with breastfeeding 3-4 meals per day plus breastfeeding ¾ th one 250 ml cup or bowl and gradually increase to 1 cup or bowl along with breastfeeding 2 - 5 years Family meals 3-4 meals plus breastfeeding and depending upon child's appetite 1-2 snacks to be offered 3 with 1-2 snacks depending on appetite Balamrutham + Recipe 1.
Wash your hands before preparing balamrutham +.

Make sure bowl and cups used in preparation are thoroughly cleansed 2.

Store balamrutham+ in a clean air tight container.

3.

Take clean drinking water for mixing 4.

Add recommended quantity of balamrutham + in a bowl and mix it while adding equal quantity of water.

5.

Stir until the smooth paste is prepared and feed immediately using a clean spoon.

6.

It is recommended that a fresh feed is prepared for child at every meal time.
Remember- Mother should always wash her own and child's hand before feeding.

Cleanliness should be endured in and around child and while preparing and storing food.

5 Ÿ Young children have small stomach size.

They can eat limited quantity at a time.

It is important to make it energy dense.


Ÿ Cook cereals in milk for eg porridge in milk Ÿ Add butter/ghee/oil or jaggery from top to increase energy and enhance the taste Ÿ Add peanut powder to meals Ÿ Ÿ Try to include variety of seasonal vegetable and fruits in your child's diet Include fermented food items in the meal eg- idli, dosa Ÿ Grains can be sprouted, roasted and then dried.

A powder can be made out of these dried grains which can be added into food items.
Follow up after discharge Follow up Schedule One month Second month Third month Fourth month Fifth month Sixth month Anthropometry and clinical sign Edema (y/n) Weight (kg) Height (cm) WHZ MUAC (cm) Any complaint (Loose motion/vomiting/ cough/ anyother) Remarks (absence due to migration, referred to NRC) Referral required either to NRC or SSFP (Yes/NO) History and Examination (SSFP) SAM Card SAM Card Basic Information Name of Child Mother’s Name Name of the AWC/Code Mother’s Adhaar No.
District DOB Sex Male/Female Date of admission in SSFP Age (months) at time of admission Anganwadi Teacher Name ANM Name Anganwadi Teacher Contact No.

ANM contact No.
SSFP visits schedule (to be filled by AWT) 1st month 2nd month 3rd month 4th month Registration visits (W1) W2 weekly W3 weekly W4 weekly W6 fortnightly W8 fortnightly W10 fortnightly W12 fortnightly W14 fortnightly W16 fortnightly Anthropometric Assessment Appetite observation at AWC on follow up visits Micronutrient Supplementation & Deworming Date Weight (kg) Height (cm) WHZ (put a tick mark in appropriate color box) MUAC (cm) Any Complications Edema (Y/N) Loose motion (Y/N) Vomiting (Y/N) Cough (Y/N) Fever (Y/N) Any other (please specify) Appetite present (Y/N) Bi- weekly IFA supplementation (put tick mark for dose received) IFA IFA Syrup Vitamin A supplementation given(Y/N) Deworming done (Y/N) Vitamin A Albendazole Antibiotic given (Y/N) Remarks (absence due to migration, referred to NRC) Date of discharge from program SSFP feed schedule for SAM child (Please indicate no.
of scoops child had in a day) Month Week Child Weight (Kg) Packets given Scoops recommended per feed *Feeds given per day (Recommended feed four times in a day) Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 st1 month nd2 month rd3 month Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 th4 month Week 13 Week 14 Week 15 Week 16 * To be filled by care giver everyday Things to ponder What can be done to prevent malnutrition to set in child?
Ÿ Good nutrition during pregnancy and lactation will be help mother to nurture the baby better Ÿ Good hygiene and sanitation protects from infection Ÿ Practice exclusive breastfeeding for first 6 months as it provides optimal nutrition and protects from infection Ÿ Age appropriate immunization protects children from common illness Ÿ After 6 months, age appropriate complementary feeds along with continued breastfeeding, two years or beyond.
Ÿ Ensure regular growth monitoring at AWC for child Ÿ Prompt treatment and continued feeding during illness helps baby to recover sooner.

How can family support in management of malnourished child?
Ÿ Family members can support mother during exclusive breastfeeding and child care by sharing in household responsibilities with mothers Ÿ Can support mothers in ensuring provisions of healthy diet and timely visits to health facility, as required Ÿ Care and support provided by husband and mother in law gives emotional support and confidence in child bearing How to feed a child?

Ÿ Young baby should be fed directly and older children should be assisted while eating.
Both boy and girl can equal quantity of food.

Ÿ Feed slowly and patiently and encourage the child to eat, but do not force feed them Ÿ While feeding, talk and engage with child by telling them stories.

Maintain an eye contact with them.

Make feeding time for them something which they look forward too.

What things should be kept in mind for management of malnourished child?

Ÿ Should take the child to AWC for regular follow up visits.

Ÿ Ensure that child is weighed regularly at AWC.


Weight gain is the most important sign indicating child is growing well.

Ÿ Child should have normal appetite.

Ÿ Feed the balamrutham+ regularly to child as suggested by AWT.

It should not be shared with others in home.


Ÿ Try to feed the child more frequently and more nutrient- Health Facility Note: week in which mother is required to visit AWC for follow up visit are highlighted in blue dense meal Ÿ Ensure all timely vaccination and supplementation (vitamin A and Iron) is provided for them Ÿ In case of any severe health problems or lack of appetite, take the child immediately to AWT/ANM Ÿ Hygeine is maintained in child's surrounding Ÿ Clean drinking water is available 4 2 3