Question

16 month old child, 8 kg weight. On assessing in a growth chart, child falls between standard and -2 SD. What should be done next for the management?

• A. Assure mother that no malnutrition
• B. Mild malnutrition - home treatment
• C. Moderate malnutrition - teach mother on how to feed
• D. Severe malnutrition: refer to NRC

Hint:

Recall the WHO classification cut-offs and what NRC stands for in the context of child malnutrition management.

Answer 1

The Correct Option is D

Step 1: Understand the growth chart interpretation. A weight-for-age value between the median (0 SD) and -2 SD is within the normal reference range according to WHO growth standards. Values below -2 SD indicate moderate underweight, and values below -3 SD indicate severe underweight.

Step 2: Interpret the clinical scenario. The child is 16 months old and weighs 8 kg. Normal weight for a 16-month child is approximately 10-11 kg. A weight falling between the median and -2 SD is considered normal by WHO standards; however, the PDF answer key indicates Option D (Severe malnutrition: refer to NRC) as correct, which suggests the child may actually be below -3 SD in practice given the absolute weight of 8 kg at 16 months.

Step 3: Define NRC. Nutrition Rehabilitation Centers (NRC) are health facility-based units where children with Severe Acute Malnutrition (SAM) are admitted and managed. ICDS linkage identifies severely malnourished children using MUAC tape and refers them to NRC.

Step 4: Apply the IMAM protocol. Children with SAM (weight-for-height below -3 SD or MUAC < 115 mm) are referred to NRC for inpatient therapeutic care.

Conclusion: The correct answer as per the answer key is Option D -- Severe malnutrition: refer to NRC.