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Photograph of Mother and Child
Title of Women Development, Child Welfare and Disabled Welfare Department
 

“Special care and Supervised feeding” of children upto 5 years categorized under SUW/ SAM/ MAM
Although ICDS provides for “double ration” for malnourished children under 5 years, this has neither yielded the desired results nor enabled to have adequate follow up of the malnourished children. Therefore guidelines have been issued for identifying malnourished children upto 5 years by “weight for age” criteria, by “weight for height” criteria and by presentation of “bilateral pitting oedema” and to take “Special care and Supervised feeding” of such children. These guidelines are as follows
iChildren upto 5 years will be identified as Severely Underweight (SUW) as per the “weight for age” criteria and will be identified as Severe Acute Malnutrition (SAM)/Moderate Acute Malnutrition (MAM) as per the “weight for height” criteria. However children below 6 months who are SUW are automatically SAM and their height need not be measured. Also all children upto 5 years who have nutritional oedema (bilateral pitting oedema) are SAM and their weight and height need not be recorded
iiFor such identification, Anganwadi workers (AWWs) will record weight of children once in a month and will measure their height once in 3 months. Based on the “weight for age” criteria, the AWW will plot the weight for each child in the growth monitoring register and will categorize the child as Severely Underweight (SUW)/ Moderately Underweight (MUW) / Normal, if the graph for the child is in red zone, yellow zone or green zone respectively. Based on “weight for height” criteria, the AWW will use the “Reference Card” and if for a particular height the weight of the child is low/too low, the child is categorized under MAM/SAM
iiiAll children upto 6 months categorized as SUW (automatically SAM too) will be examined by Medical Officer (PHC) [MO(PHC)] and will compulsorily be referred to the Nutrition Rehabilitation Centre (NRC). In the meanwhile, the mother of such a child will be encouraged to continue exclusive breastfeeding
ivAll children upto 5 years who have nutritional oedema (bilateral pitting oedema) (automatically SAM too) will be examined by MO(PHC) and will compulsorily be referred to the NRC. In the meanwhile, supervised feeding will be provided for the child as explained hereunder
vAll children identified as SUW/ SAM/ MAM upto 5 years will be given “Special care and Supervised feeding”. For this purpose model menus have been separately prescribed for the age groups of 7 months - 3 years and 3-6 years at  Table-I and   Table-II below. As per these menus, SUW/ SAM/ MAM children will be given caloric dense food every 2 hours. Among these feeds, certain feeds (viz of egg, milk and meal + oil) will be given to “7 months – 3 years” and certain feeds (viz of egg, milk, meal +oil, snack, balamrutham) will be given to “3-6 years” at the AWC itself. The AWW will however supervise not only these feeds at the AWC but also the feeds to be given at home
viOnce identified, all SUW/SAM/MAM children, will be examined by the MO(PHC) who may prescribe medicines along with the supervised feeding. These medicines may address deworming and include vitamin/ iron/ folic acid/ calcium supplementation. Antibiotics may also be prescribed by the MO(PHC), if required, based on the medical condition diagnosed. Such medicines will be provided free of cost by the MO(PHC). The MO(PHC) will also examine such children for illnesses/medical complications and dispense medicines and advise referral, if necessary. The MO(PHC) will also advise whether a SUW/SAM/MAM child has to be referred to the NRC or not
viiChildren who do not gain any weight after 2-3 weeks of supervised feeding and prescribed medicines or do not make satisfactory progress during any stage of supervised feeding will have to be reassessed by the MO(PHC) and may have to be referred to the NRC. On return from the NRC, children may be enrolled for supervised feeding for follow up, if necessary
viiiChildren categorized as SUW/SAM/MAM need greater stimulation and warmth than others. Hence, AWW must actively interact with such children with toys/play material/story telling/ conversation etc
ixThe mothers of all SUW/SAM/MAM children will be advised by the AWW/Nutrition Counsellor/Link Worker as follows
  • To exclusively breastfeed, if the child is below 6 months of age and to take SNP either in the form of Indiramma Amrutha Hastham (IAH) or Take Home Ration (THR)
  • To continue breastfeeding, if the child is below 2 years of age and even if the child is ill
  • To follow the “Model Menu” if the child is more than 6 months old, and to enroll the child for supervised feeding at the AWC and at home
  • To administer Vitamins, IFA, Calcium and other nutritional supplementation and deworming medicines as prescribed by the MO(PHC). (Note: Antibiotics will be administered only when specifically indicated and prescribed by the MO(PHC) based on the diagnosis in an individual case)
  • To ensure immunization as per the prescribed schedule
  • To use safe drinking water and follow desired hygiene behaviour particularly of washing hands before feeding the child
  • To interact actively with the child with toys/play material/story telling/ conversation etc. and to keep the child warm, if necessary
  • To monitor growth of the child by checking weight once in a week
xThe Supervisors will ensure that all SUW/SAM/MAM children in their jurisdiction are systematically identified. The lists of such children will be displayed in each AWC along with details of follow up action and the progress in growth. The Supervisors will also ensure that such lists are shared with the concerned ANM and MO (PHC)
xiThe ANMs and MOs(PHC) will help identify SUW/SAM/MAM children, assess their progress and MOs(PHC) will prescribe medicines, examine for medical complications and advise referral, if necessary
xiiThe CDPOs/PDs/RJDs will support and closely monitor the “Special care and Supervised feeding” of such children at the AWCs and at their homes
xiiThe Commissioner, Women Development & Child Welfare, Hyderabad will ensure effective implementation, undertake training, capacity building and name based monitoring for the “Special care and Supervised feeding” of SUW/SAM/MAM children. The Commissioner will also get evaluation studies carried out by independent agencies
xiiiFor the purpose of monitoring “Special care and Supervised feeding” of SUW/SAM/MAM children
  • The AWWs will maintain a register for “Special care and Supervised feeding” as per format enclosed at Annexure-I. The name- based information in this register will be entered in the CDPOs computer every month, for which software is under development
  • The AWWs will also submit monthly report to CDPOs as per format enclosed at Annexure-II. This report will be counter signed by the ICDS supervisor
  • The CDPOs inturn will submit online Monthly Progress Report (MPR)-11 as per format enclosed at Annexure- III by 5th of every month
  • The ICDS Supervisors will also maintain a register for “Special care and Supervised feeding” as per the same format as prescribed for the AWWs. The Supervisors will also furnish every month the list of SUW/SAM/MAM children to the Medical Officers (PHC) as per format enclosed at Annexure-IV, so as to enable timely checkup and follow-up by the Medical Officers
3.References
G.O.Ms.No.14 - Dated:28-02-2014
Supplementary Nutrition Programme (SNP) under Integrated Child Development Service (ICDS) Scheme - Food Models for ICDS beneficiaries – Revised and Comprehensive Orders – Issued
G.O.Ms.No.15 - Dated:28-02-2014
Supplementary Nutrition Programme (SNP) under Integrated Child Development Service (ICDS) Scheme – “Special care and Supervised feeding” of children upto 5 years categorized under Severely Underweight (SUW)/ Severe Acute Malnutrition (SAM)/ Moderate Acute Malnutrition (MAM) – Guidelines – Issued
G.O.Ms.No.87 - Dated:07-05-2014
Health, Medical and Family Welfare Department – Reducing malnutrition among children- Action to be taken by health functionaries to coordinate with Department for Women, Children, Disabled and Senior Citizens(WCD&SCs), for “Special care and Supervised feeding” of Severely Underweight (SUW)/ Severe Acute Malnutrition (SAM)/ Moderate Acute Malnutrition (MAM) children upto 5 years – Guidelines – Issued
G.O.Ms.No.20 - Dated:21-05-2014
Supplementary Nutrition Programme (SNP) under Integrated Child Development Service (ICDS) Scheme – Revised and comprehensive guidelines on “Food Models” for ICDS beneficiaries - “Special care and Supervised feeding” of children upto 5 years categorized under Severely Underweight (SUW)/ Severe Acute Malnutrition (SAM)/ Moderate Acute Malnutrition (MAM) – Certain instructions for monitoring - Issued