Malnutrition Follow-up

  • Author: Harohalli R Shashidhar, MD; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
Updated: Mar 10, 2016

Further Outpatient Care

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  • Monitor patients closely for growth and resolution of clinical signs and symptoms of malnutrition. Follow-up should be based on the severity of the illness, age of the patient, and the patient's initial response to intervention.
  • Minimal intervals between visits should give the patient sufficient time to show a change in the measured parameter. For example, in infants beyond the newborn stage, the time needed to show an appreciable change in weight is 7 days. A 4-week interval is needed to document changes in length, and an 8-week interval is needed to document a change in height.


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  • Prevention of malnutrition in children starts with an emphasis on prenatal nutrition and good prenatal care. Health care providers should emphasize the importance of breastfeeding in the first year of life. Promotion of breastfeeding is particularly crucial in developing countries where safe alternatives to human milk are unavailable. In addition to the promotion of breastfeeding, health care providers should counsel parents on the appropriate introduction of nutritious supplemental foods. Health care providers should continue to provide age-appropriate nutritional counseling at every opportunity.
  • Programs addressing micronutrient supplementation and fortification have been successful at decreasing the incidence of specific micronutrient deficiencies (eg, iodine, vitamin D) in many countries, and supplementation in pregnant women has also been beneficial.[13, 14] These programs should be promoted more in developing countries. In addition, research demonstrates that zinc supplementation can help reduce the duration and severity of acute and persistent diarrheal illnesses in children in areas where diarrhea is a significant cause of mortality and is recommended by the World Health Organization and UNICEF.[15, 16] Additional fortification programs should be developed to address other common nutritional deficiencies such as iron deficiency, which continues to be significant problem throughout the world.
  • Improvement in hygiene practices and sanitation reduces the incidence of infectious diseases, which decreases the incidence of malnutrition in developing countries.


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  • Children who have chronic malnutrition, especially those with intrauterine growth retardation and with onset at an early age, do not achieve their full growth potential or regain cognitive deficits. Although malnutrition is rare in the United States and other industrialized countries, over half of childhood mortality in developing countries is either directly or indirectly secondary to malnutrition.
Contributor Information and Disclosures

Harohalli R Shashidhar, MD Associate Professor, Department of Pediatrics, Chief, Division of Pediatric Gastroenterology and Nutrition, University of Kentucky Medical Center

Harohalli R Shashidhar, MD is a member of the following medical societies: American Academy of Pediatrics, Kentucky Medical Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.


Donna G Grigsby, MD Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine

Donna G Grigsby, MD is a member of the following medical societies: Kentucky Chapter of The American Academy of Pediatrics, Kentucky Pediatric Society, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, FAAP Professor of Pediatrics, Medical College of Georgia, Georgia Regents University; Chief, Division of Neonatology, Director, Fellowship Program in Neonatal-Perinatal Medicine, Director, Transport/ECMO/Nutrition, Vice Chair, Clinical Research, Department of Pediatrics, Children's Hospital of Georgia

Jatinder Bhatia, MBBS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, Academy of Nutrition and Dietetics, Society for Pediatric Research, Southern Society for Pediatric Research

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Gerber.

Additional Contributors

Maria Rebello Mascarenhas, MBBS Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief of Nutrition, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia

Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

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Hormonal adaptation to the stress of malnutrition: The evolution of marasmus.
A classic example of a weight chart for a severely malnourished child.
This infant presented with symptoms indicative of a dietary protein deficiency, including edema and ridging of the toenails. Image courtesy of the Centers for Disease Control and Prevention.
This infant presented with symptoms indicative of Kwashiorkor, a dietary protein deficiency. Note the angular stomatitis indicative of an accompanying Vitamin B deficiency as well. Image courtesy of the Centers for Disease Control and Prevention.
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