National Nutrition and HIV/AIDS Guidelines for Service Providers of ...

° Ensure that all immunizations and vitamin A supplementation have been recorded on the
CWC
° Counsel mothers/caretakers about the importance of taking their children for monthly
growth promotion and monitoring.
° Children brought for growth monitoring should be weighed accurately; children should
be weighed without shoes, diapers and clothing.
° The weights should be plotted accurately against the ages on the Child Welfare Card.
° Mothers or caregivers whose children have growth failure should be advised accordingly.
° Nutrition counseling should be given to all mothers/caretaker irrespective of the growth
status/pattern of the child.
° Mothers should be counseled on proper care and use of the CWC.
° The child's diet should be reviewed at every contact to ensure appropriate feeding.
° Help mothers to practice active responsive feeding
° Assess and promote good hygiene and proper food and water safety and handling (as
detailed in Chapter 8.)
° Encourage mothers to seek healthcare and support if the child is either not growing well,
loosing weight, has eating problems, has sores/ulcers in its mouth, or gets opportunistic
and other infections, such as malaria/fever, diarrhoea and respiratory infections.
° Promote continued adequate dietary care and support during and after illness.
Create awareness about psychological and socio-economic support that households with
HIV/AIDS infected children can access in their locality
5.3.3 Nutritional care and support for children over 2 years
In addition to providing nutrition care and support guidelines for children 6 24 months, mothers of
children 2 years and older must be advised to provide children with a balanced diet that is based on the
principles of a healthy diet as detailed in Chapter 2. However the portions of the food provided must be
smaller than adult portions to match those recommended for children. In general serving portions for
children are about ½ of adult sizes. As the child grows the amount of food given should be increased
gradually.
5.3.4 Care and Support for Severely Malnourished Children with HIV/AIDS
Severely malnourished children with HIV/AIDS are about five times more likely to die than uninfected
children. Such children rarely respond to conventional nutritional rehabilitation and take much longer
to recover. Providers are strongly encouraged to refer children with acute and severe malnutrition
to the hospital where they can receive care from a team of medical doctors and dietitians. All
children with weight for height less than 70% or below -3 standard deviations with or without oedema
are considered to have acute and severe malnutrition.
The Management of severely malnourished children with HIV involves achieving high energy and high
nutrient intakes to realize complete recovery. However, the high energy and nutrient dense diet
should be progressed as tolerated and with extreme caution. Given the seriousness of severe
malnutrition in all children let alone those infected with HIV, providers should encourage caregivers to
request healthcare promptly when children are not growing well. To this end, regular attendance of
Growth Monitoring should be encouraged. In addition to all these, providers must familiarize
themselves with the signs and symptoms of severe malnutrition. Refer to the Tables 5.1 for the
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