1st Action. Ask about general condition and if child is on any treatment including ART and TB medicine?
  • Also check immunizations (Step 7).
  • Is the child at school?
  • If child is on ART then also complete Step 10. Check if ART dose needs to be adjusted up.
2nd Action. Check mother's health (+ need for ART) and care of other children
3rd Action . Nutrition counselling
  • Encourage mother/caregiver indicating that the child is growing well. Explain growth chart and how to follow progress.
  • Ask, have there been any major changes in the child's circumstances from the last visit that might put the care of the child at risk, including access to food?
  • Advise mother/caregiver why additional food (energy) is needed in children (and adults) with HIV infection (approx 10%).
  • Counsel on continued breastfeeding if mother is well (check national guidelines related to breastfeeding policy and age of the child).
  • Counsel on complementary feeding and replacement feeding (frequency of meals, amount and type of food per meal, responsive feeding – see Appendices VI and VII). Reinforce and encourage good practices.
  • Counsel on feeding a variety of foods such as milk, fruit, vegetables, whole grains, cereals and meat/chicken or fish based on local diets i.e. food sources that are high in vitamin A, iron, calcium, etc. and other locally produced foods.
  • Review safe food preparation, food and water storage methods and hygiene issues (keep hands, utensils and food preparation area clean; separate raw and cooked foods; cook food thoroughly; keep food at safe temperature; use safe water and food).
  • Check if there are other sources of good foods such as garden projects or other community resources.
4th Action. Meet age-specific needs and additional 10% energy based on actual weight
Examples of ways to increase energy intake by 10% using food
Give in addition to the meals and snacks appropriate for the child's age
6-11 months [additional 60-75 kcal = Total ∼760 kcal/day]
  • Local adaptation – Give examples and quantities of local foods that can be used to increase energy density of other foods e.g. 2 tsp margarine/oil and 1-2 tsp sugar to porridge or that can be given in addition to normal diet.
12-23 months [additional 80-95 kcal = Total ∼990 kcal/day]
  • Local adaptation – Give examples and quantities of local foods that can be used to increase energy density of other foods e.g. margarine/oil and sugar to porridge or that can be given in addition to normal diet.
2-5 years [additional 100-140 kcal = Total ∼1390 kcal/day]
  • Local adaptation – Give examples and quantities of local foods that can be used to increase energy density of other foods or that can be given in addition to normal diet e.g. extra cup of full cream milk/fermented milk.
6-9 years [additional 130-190 kcal = Total ∼1815 kcal/day]
  • Local adaptation – Give examples and quantities of local foods that can be used to increase energy density of other foods or that can be given in addition to normal diet e.g. extra cup of full cream milk/fermented milk.
10-14 years [additional 170-230 kcal = Total ∼2200 kcal/day]
  • Local adaptation – Give examples and quantities of local foods that can be used to increase energy density of other foods or that can be given in addition to normal diet e.g. extra cup of fruit yoghurt or cheese/peanut butter sandwich.
5th Action. Ensure adequate micronutrient intake
  • If the child's diet is not balanced and does not contain a variety of animal sourced foods, fruits and vegetables then give a daily micronutrient supplement that provides 1 Recommended Daily Allowance of a wide range of vitamins and other micronutrients. Refer to national guidelines.
6th Action. Vitamin A supplements every 6 months
  • 6-12 months 100 000 IU 1-5 years 200 000 IU
    Do not give if child has received dose within the past month e.g. from hospital
7th Action. De-worm every 6 months (Step 7)
  • Albendazole (oral) 400 mg single dose every 6 months after first year of life.
8th Action. Cotrimoxazole prophylaxis (Step 7)
  • Provide from 6 weeks of age 5 mg/kg/day. See step 7 for guidance on when to stop.
9th Action. Ensure mother/caregiver understands care plan and ask if she/he has any questions

10th Action. Review in 2-3 months (tell caregiver to return earlier if problems arise).
For children >5 yrs, vitamin A should be provided through regular daily micronutrient supplements

From: Step 3, Decide a Nutrition Care Plan

Cover of Guidelines for an Integrated Approach to the Nutritional Care of HIV-Infected Children (6 Months-14 Years)
Guidelines for an Integrated Approach to the Nutritional Care of HIV-Infected Children (6 Months-14 Years).
Copyright © 2009, World Health Organization.

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