Infant and child nutrition

Red Flags

Severe acute malnutrition (weight-for-height < -3 SD, MUAC <11.5 cm in 6–59 months, bilateral pitting oedema) — admit for inpatient stabilisation; F-75/F-100 therapeutic feeds; treat infection^[1]
Failure to thrive with crossing two centiles downward — investigate medical and social causes; do not assume normal variant^[1]
Vitamin A deficiency with eye signs (Bitot's spots, corneal ulcer) — emergency vitamin A 200,000 IU PO immediately; ophthalmology^[1]
Childhood obesity with metabolic features (acanthosis, hypertension, dyslipidaemia, fatty liver on USG) — investigate for T2DM and metabolic syndrome^[1]

Exclusive breastfeeding 0–6 months^[1]
Initiate within 1 hour of birth; on-demand feeding day and night; no other foods or fluids including water; warm support and counselling for difficulties (latch, supply, cracked nipples)
Complementary feeding from 6 months^[1]
Continue breastfeeding alongside; introduce mashed/pureed family foods; texture and variety progressively; achieve 3–5 meals/day by 12 months; include iron-rich foods, animal source foods, fruits, vegetables
Promote diverse, indigenous, minimally-processed diet^[1]
Millets, local grains, pulses, seasonal fruits and vegetables, dairy where consumed, eggs, fish; limit sugar, salt, and ultra-processed foods; family foods rather than special baby foods after 9–12 months
Universal supplementation programmes^[1]
Vitamin A 100,000 IU PO at 9 months, then 200,000 IU 6-monthly until 5 years (UIP). Iron-folic acid syrup 8–10 mg elemental iron + 100 µg folic acid biweekly 6–59 months (Anaemia Mukt Bharat). Universal salt iodisation. Periodic deworming albendazole 400 mg 6-monthly 1–19 years
Growth monitoring and counselling at every visit^[1]
Weigh and plot at every well-child visit; deviations (flat curve, crossing centiles, sudden drop) trigger nutritional assessment and intervention

Drug	Class	Adult	Paediatric	Notes
Vitamin A^[1]	Fat-soluble vitamin	Not applicable — paediatric guideline	9 months: 100,000 IU PO once. 1–5 years: 200,000 IU PO every 6 months. Acute SAM or measles: 200,000 IU PO × 3 doses (day 1, 2, 14)	Universal supplementation in high-deficiency settings (UIP); also given with measles vaccine; contraindicated in pregnancy
Iron-folic acid (paediatric formulation)^[1]	Iron + B-vitamin combination	Not applicable — paediatric guideline	Anaemia Mukt Bharat: 8–10 mg elemental iron + 100 µg folic acid syrup biweekly 6–59 months; tablet weekly 5–10 years; treatment dose for IDA 3–6 mg/kg/day	Programme supplementation reduces IDA prevalence; treat IDA with elemental iron 3–6 mg/kg/day for 3 months
Albendazole (deworming)^[1]	Anthelminthic (benzimidazole)	Not applicable — paediatric guideline	≥12 months: 400 mg PO single dose every 6 months	National Deworming Day biannual programme 1–19 years; reduces helminth burden, anaemia, and malnutrition
F-75 / F-100 therapeutic milk (SAM inpatient)^[1]	Therapeutic feed	Not applicable — paediatric guideline	F-75 stabilisation 130 mL/kg/day; transition to F-100 at rehabilitation 150–200 mL/kg/day	Inpatient management of SAM at NRC/MTC per WHO 10-step protocol; outpatient via RUTF for uncomplicated SAM

Vitamin A^[1]

Fat-soluble vitamin

Adult: Not applicable — paediatric guideline
Paediatric: 9 months: 100,000 IU PO once. 1–5 years: 200,000 IU PO every 6 months. Acute SAM or measles: 200,000 IU PO × 3 doses (day 1, 2, 14)

Universal supplementation in high-deficiency settings (UIP); also given with measles vaccine; contraindicated in pregnancy

Iron-folic acid (paediatric formulation)^[1]

Iron + B-vitamin combination

Adult: Not applicable — paediatric guideline
Paediatric: Anaemia Mukt Bharat: 8–10 mg elemental iron + 100 µg folic acid syrup biweekly 6–59 months; tablet weekly 5–10 years; treatment dose for IDA 3–6 mg/kg/day

Programme supplementation reduces IDA prevalence; treat IDA with elemental iron 3–6 mg/kg/day for 3 months

Albendazole (deworming)^[1]

Anthelminthic (benzimidazole)

National Deworming Day biannual programme 1–19 years; reduces helminth burden, anaemia, and malnutrition

F-75 / F-100 therapeutic milk (SAM inpatient)^[1]

Therapeutic feed

Adult: Not applicable — paediatric guideline
Paediatric: F-75 stabilisation 130 mL/kg/day; transition to F-100 at rehabilitation 150–200 mL/kg/day

Inpatient management of SAM at NRC/MTC per WHO 10-step protocol; outpatient via RUTF for uncomplicated SAM

Exclusive breastfeeding for the first 6 months — water, gripe water, and supplementary feeds harm infant gut and reduce milk supply^[1]
Watch for slowing weight gain, lack of interest in food, lethargy, persistent diarrhoea, or recurrent infections — seek paediatric review^[1]
Limit sweetened drinks and ultra-processed snacks — they displace nutritious food and contribute to dental caries and overweight even in early childhood^[1]

Severe acute malnutrition with complications (oedema, hypoglycaemia, hypothermia, pneumonia, sepsis, refusal to feed)Nutrition Rehabilitation Centre (NRC) or paediatric admission^[1]
Failure to thrive, persistent stunting, or growth faltering despite community-level supportPaediatric outpatient with social work involvement^[1]
Childhood obesity with metabolic featuresPaediatric endocrinology and dietitian^[1]
Suspected feeding disorder, congenital syndrome, or inborn error affecting nutritionPaediatric subspecialty^[1]

Breastfeeding, complementary feeding, supplementation, and screening for under- and over-nutrition in children aged 0–10 years.

1.ICMR-NIN Dietary Guidelines for Indians (2024 update); WHO/UNICEF Global Strategy for Infant and Young Child Feeding; IAP Standard Treatment Guidelines for Nutrition (2024)