Pediatric undernutrition – Public health perspective

Child undernutrition remains a critical public health challenge in India, affecting millions of children and hindering the nation’s social and economic progress. Despite significant advancements in healthcare and nutrition programs, India continues to struggle with high rates of stunting, wasting, and underweight among children under 5 years of age. Factors such as poverty, food insecurity, inadequate and faulty child care, poor sanitation, and lack of awareness contribute to the crisis. Secondary causes of malnutrition also contribute to the burden of undernutrition and this group needs to be managed carefully. Infants are at risk of poor growth and development (also known as early growth failure) and are a population of babies whose early identification and intervention are crucial to prevent long-term consequences such as stunting, cognitive delays, and increased disease susceptibility. Key risk factors in such babies include poor maternal health and nutrition, preterm birth and low birth weight, inadequate breastfeeding, and lack of early stimulation and responsive parenting. The Indian government, along with international organizations, has implemented various interventions such as nutrition rehabilitation centers (NRCs) which are specialized healthcare facilities in India aimed at providing medical and nutritional care to children suffering from severe acute malnutrition (SAM). These centers play a crucial role in addressing child malnutrition by offering treatment, counseling, and follow-up care. The aim of this review is focused on understanding public health strategies to tackle pediatric undernutrition in our country. For community screening and management, Poshan Abhiyaan (National Nutrition Mission) to combat child malnutrition has been initiated. Key screening methods used in Poshan Abhiyaan 2.0 include anthropometric measurements like weight-for-age (underweight) for underweight children. Height-for-age (stunting) identifies chronic malnutrition and weight-for-height (wasting) detects acute malnutrition. Growth monitoring through Integrated Child Development Services (ICDS) and Anganwadi centers including monthly weight and height tracking of children is done under ICDS. The use of mother and child protection cards for recording growth trends is essential. Community-based screening by frontline workers such as anganwadi workers, accredited social health activists (ASHA), and auxiliary nurse midwives is conducted through regular home visits for identification of low birth weight, feeding difficulties, and signs of malnutrition. Digital tools and mobile applications such as Poshan tracker record real-time nutritional data for targeted interventions. Anemia Mukt Bharat Dashboard tracks anemia levels in children. Follow-up and referral protocol includes moderate acute malnutrition cases which are managed through home-based care and nutritional counseling and SAM cases which are referred to NRCs for specialized care.