Malnutrition Treatment & Management

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

Medical Care

Following evaluation of the child's nutritional status and identification of the underlying etiology of the malnutrition, dietary intervention in collaboration with a dietitian or other nutritional professionals should be initiated. Children with edema must be assessed carefully for actual nutritional status because edema may mask the severity of malnutrition. Children with chronic malnutrition may require caloric intakes more than 120-150 kcal/kg/d to achieve appropriate weight gain. The formula for determining adequate caloric intake is:

kcal/kg = (RDA for age X ideal weight)/actual weight

Additionally, any micronutrient deficiencies must be corrected for the child to attain appropriate growth and development. Most children with mild malnutrition respond to increased oral caloric intake and supplementation with vitamin, iron, and folate supplements. The requirement for increased protein is met typically by increasing the food intake, which, in turn, increases both protein and caloric intake. Adequacy of intake is determined by monitoring weight gain.

A Cochrane Database of Systematic Reviews study noted that micronutrient powders (MNPs), which are single-dose packets containing multiple vitamins and minerals in powder form for sprinkling onto any semisolid food, can effectively reduce anemia and iron deficiency in children aged 6-23 months. While the benefits of this intervention as a survival strategy or on developmental outcomes are unclear, the use of MNP is possibly comparable to daily iron supplementation and better than placebo or no intervention.[10]

In mild-to-moderate cases of malnutrition, initial assessment and nutritional intervention may be done in the outpatient setting. A patient with malnutrition may require hospitalization based on the severity and instability of the clinical situation. Hospitalization of patients with suspected malnutrition secondary to neglect allows observation of the interactions between parent/caregiver and child and documentation of actual intake and feeding difficulties. It may also be warranted in cases where dehydration and acidosis complicate the clinical picture. In moderate-to-severe cases of malnutrition, enteral supplementation via tube feedings may be necessary.

A study by Stobaugh et al found that the proportion of children that recovered from moderate acute malnutrition was significantly higher in the group that received ready-to-use supplementary food containing dairy ingredients in the form of whey permeate and whey protein concentrate than in the group that received soy ready-to-use supplementary food. The authors added that this study highlighted the importance of milk protein in the treatment of moderate acute malnutrition.[11]



See the list below:

  • Any child at risk for nutritional deficiency should be referred to a registered dietitian or other nutritional professional for a complete nutritional assessment and dietary counseling.
  • In the United States, children with poor nutrition secondary to inadequate intake should be referred to the appropriate social agencies to assist the family in obtaining resources and providing ongoing care for the child.
  • Other subspecialty referrals are based on findings in the initial evaluation that may indicate a specific cause of inadequate nutrition other than inadequate food intake.


See the list below:

  • Dietary guidelines were released by the US Department of Health and Human Services and the US Department of Agriculture in 2005. [12]
  • Protein, energy, and other nutrient requirements vary with age, sex, and activity levels.
  • Following careful assessment of the child's nutritional status, initiate nutritional intervention in collaboration with nutrition support personnel.
  • Children with chronic malnutrition may require caloric intakes in excess of 120-150 kcal/kg/d to achieve appropriate weight gain. The diet must include adequate amounts of protein and other macronutrients.
  • Any micronutrient deficiencies must be diagnosed and corrected to achieve adequate somatic growth and psychomotor development.
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.

  1. Balint JP. Physical findings in nutritional deficiencies. Pediatr Clin North Am. 1998 Feb. 45(1):245-60. [Medline].

  2. WHO. Malnutrition-The Global Picture. World Health Organization. Available at

  3. Blossner, Monika, de Onis, Mercedes. Malnutrition: quantifying the health impact atnational and local levels. 2005. Available at

  4. Hendricks KM, Duggan C, Gallagher L, et al. Malnutrition in hospitalized pediatric patients. Current prevalence. Arch Pediatr Adolesc Med. 1995 Oct. 149(10):1118-22. [Medline].

  5. Benitez-Bribiesca L, De la Rosa-Alvarez I, Mansilla-Olivares A. Dendritic spine pathology in infants with severe protein-calorie malnutrition. Pediatrics. 1999 Aug. 104(2):e21. [Medline].

  6. World Health Organization. WHA Global Nutrition Targets 2025: Low Birth Weight Policy Brief. World Health Organization. Available at 2014;

  7. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr. 1999 Aug. 129(8):1555-62. [Medline].

  8. Heywood AH, Marshall T, Heywood PF. Motor development and nutritional status of young children in Madang, Papua New Guinea. P N G Med J. 1991 Jun. 34(2):109-16. [Medline].

  9. Martorell R, Rivera J, Kaplowitz H, Pollitt E. Long-term consequences of growth retardation during early childhood. Hernandez M, Argente J. Human growth:basic and clinical aspects. Amsterdam: Elsevier Science Publishers; 1992. 143-149.

  10. De-Regil LM, Suchdev PS, Vist GE, Walleser S, Peña-Rosas JP. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database Syst Rev. 2011 Sep 7. 9:CD008959. [Medline].

  11. Stobaugh HC, Ryan KN, Kennedy JA, Grise JB, Crocker AH, Thakwalakwa C, et al. Including whey protein and whey permeate in ready-to-use supplementary food improves recovery rates in children with moderate acute malnutrition: a randomized, double-blind clinical trial. Am J Clin Nutr. 2016 Mar. 103 (3):926-33. [Medline].

  12. US Department of Health and Human Services, US Department of Agriculture. Dietary guidelines for Americans, 2005. US Department of Health and Human Services. 2005.

  13. Zeng L, Dibley MJ, Cheng Y, et al. Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial. BMJ. 2008 Nov 7. 337:a2001. [Medline].

  14. Roberfroid D, Huybregts L, Lanou H, et al. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. 2008 Nov. 88(5):1330-40. [Medline].

  15. Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2008 Jul 16. CD005436. [Medline].

  16. Scrimgeour AG, Lukaski HC. Zinc and diarrheal disease: current status and future perspectives. Curr Opin Clin Nutr Metab Care. 2008 Nov. 11(6):711-7. [Medline].

  17. Barber J. Antibiotics Help in Malnutrition Treatment in Children. Medscape Medical News. Jan 30 2013. Available at Accessed: February 5, 2013.

  18. Blecker U, Mehta DI, Davis R, et al. Nutritional problems in patients who have chronic disease. Pediatr Rev. 2000 Jan. 21(1):29-32. [Medline].

  19. Caulfield LE, de Onis M, Blossner M. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr. 2004 Jul. 80(1):193-8. [Medline].

  20. Chandra RK. 1990 McCollum Award lecture. Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr. 1991 May. 53(5):1087-101. [Medline].

  21. de Onis M, Blossner M, Borghi E. Estimates of global prevalence of childhood underweight in 1990 and 2015. JAMA. 2004 Jun 2. 291(21):2600-6. [Medline].

  22. de Onis M, Frongillo EA, Blossner M. Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bull World Health Organ. 2000. 78(10):1222-33. [Medline].

  23. Hay WW Jr, Lucas A, Heird WC, et al. Workshop summary: nutrition of the extremely low birth weight infant. Pediatrics. 1999 Dec. 104(6):1360-8. [Medline].

  24. Islam S, Abely M, Alam NH, et al. Water and electrolyte salvage in an animal model of dehydration and malnutrition. J Pediatr Gastroenterol Nutr. 2004 Jan. 38(1):27-33. [Medline].

  25. Kleinman RE, Murphy JM, Little M, et al. Hunger in children in the United States: potential behavioral and emotional correlates. Pediatrics. 1998 Jan. 101(1):E3. [Medline].

  26. Kleinmann R, Committee on Nutrition. Pediatric Nutrition Handbook. 4th ed. American Academy of Pediatrics; 1998.

  27. Koerner CB, Hays TL. Food allergy: current knowledge and future directions. Immunol Allergy Clin North Am. 1999. 19.

  28. Man WD, Weber M, Palmer A, Schneider G, Wadda R, Jaffar S. Nutritional status of children admitted to hospital with different diseases and its relationship to outcome in The Gambia, West Africa. Trop Med Int Health. 1998 Aug. 3(8):678-86. [Medline].

  29. Muller O, Krawinkel M. Malnutrition and health in developing countries. CMAJ. 2005 Aug 2. 173(3):279-86. [Medline].

  30. Rosenfield RL. Essentials of growth diagnosis. Endocrinol Metab Clin North Am. 1996 Sep. 25(3):743-58. [Medline].

  31. Trehan I, Goldbach HS, LaGrone LN, Meuli GJ, Wang RJ, Maleta KM, et al. Antibiotics as part of the management of severe acute malnutrition. N Engl J Med. 2013 Jan 31. 368(5):425-35. [Medline].

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.
Medscape Consult