What is catch-up growth?
Catch-up growth is a faster-than normal rate of weight and length gain that occurs when a child receives more calories and protein upon arrival at home. Catch-up growth occurs among most adoptees, but is critical among children who are severely malnourished.
What is refeeding syndrome?
Refeeding syndrome consists of many fluid and electrolyte disturbances that occur when children are given too many nutrients too quickly. To avoid the syndrome in severely malnourished children, it is better to consult with a paediatrician/ dietician.
Is it difficult for children to catch up with high calorific/protein rich foods in the initial stages?
Yes, it may be difficult in the initial stages for some children so it would be useful to consult a paediatrician /dietician.
Is it important to consult a paediatrician or a nutritionist in the initial stages for severely malnourished child?
Yes, one should consult a paediatrician/nutritionist/dietician.
What are the common lab tests that one can do to ascertain dietary deficiencies?
CBC, and differential count (diff), including red blood cell count, haemoglobin, haematocrit, and red blood cell indices (including mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration).

Decreased levels may indicate anaemia (including iron-, folate- and B12-deficiency anaemia), chronic illness, lead poisoning, chronic diseases or nutritional deficiency. Note: High haemoglobin levels may be found in children who lived in high altitudes.

Serum Ferritin Transferrin Receptor

Checks for adequate levels of iron stores (ferritin) and cellular iron status (transferrin receptor). Both can potentially detect iron deficiency before anaemia occurs.

Thyroid Stimulating Hormone (TSH)

Tests for deficiency of thyroid hormone, which in turn could be due to deficiency of iodine in the in the diet.

25-hydroxy Vitamin D

Tests for vitamin D levels, which may demonstrate a risk of rickets.

Stool test for ova and parasites

Tests for infectious diseases of the gut, which if left untreated can inhibit nutrient absorption.

Antigen Heliobacter Pylorii

Tests for infectious diseases of the gut, which if left untreated can inhibit nutrient absorption.

Serum Zinc

Tests for zinc levels. Deficiency can put children at a great risk for infectious disease and atypical cognitive development.


Tests for vitamin B12. Deficiency can increase risk for neuropsychiatric and neurologic complications.

Standard Anthropometric:

Indication of adequacy of protein and energy intake/uptake. Measures height/length, weight and head circumference. In general, it’s more important to maintain growth than to reach a certain percentile of growth, though this may differ according to each child’s unique needs.

What is the best way to accelerate/ facilitate growth?
The best way to do this is by adding calories/protein to foods they want to eat. Every bite counts for slow/poor eaters, so boosting the meals with extra calories/protein is important. For example, add almond powder to oatmeal.
What are the invisible boosters of protein and micronutrients that can be added to meals?
  • Add nuts/fig/date paste to oatmeal
  • Puree legumes and add it to sauces, soups.
What are the probable causes for undernutrition in some adopted children?
  • Insufficient maternal nutrition during the period of gestation
  • Improper infant nutrition and care in the adoption centres
  • Co-existing infections
  • Post-adoption growth spurts
What are the common nutritional deficiencies during this transition and how to overcome them?
The most common are

  • Calcium deficiency
  • Folate deficiency
  • Iodine deficiency’
  • Iron deficiency anemia
  • Protein Energy malnutrition
  • Vitamin A deficiency
  • Vitamin B12 deficiency anemia
  • Vitamin D deficiency (Rickets)
  • Zinc deficiency
What are the first signs of nutritional deficiencies?
  • Depression & anxiety
  • Hyperactivity
  • Delayed speech
  • Dry skin and hair
  • Crowding of teeth, discoloured and late eruption of teeth
  • Cavities
  • Low immunity to coughs and cold
  • Cranky or sporadic emotions
  • Poor cranial structure or a flat head structure
  • Tired, listless child
  • Light or brown coloured hair
What is the best infant formula available in India? How nutritious are the commercially available formula?
Baby formula is the next best substitute for breast milk. Most of the milk based formula are manufactured to act as substitutes or alternatives to breast milk.

  • Similac Advance
  • Lactogen
  • Enfamil A+
  • Farex Stage 1
  • Nutricia Dexolac
How to select baby formula?
When buying a baby formula, check for its form, the type of protein, carbohydrate it contains and the list of other ingredients used for its preparation. It is a must to choose a formula that is easy to dissolve in boiled water and does not leave any lumps. Also please check for milk allergies with your pediatrician prior to starting the formula.

  • Iron fortified infant formula to be used for the first 9-12 months. The formula should be cow’s milk-based.
How best to prepare formula food?
Read the instructions on the formula’s packaging to find out how much water and how much powder you need, adding more or less formula than instructed could make infants ill.
What are some easy homemade nutritious foods?
Here are a few simple recipes that provide optimal nutrition. These are non-commercial, scientifically proven recipes brought out by the National Institute of Nutrition and used by many doctors to treat protein energy malnutrition. They are inexpensive, made with commonly available items, non-time consuming and most importantly, highly effective!

Davengere Mix: It adequately provides protein as well as energy deficiencies and is widely used to bridge PEM (Protein Energy Malnutrition)
A mix of 1 part each of ragi, roasted bengal gram powder, roasted groundnut powder and syrup of jaggery
One 100 gm ball provides:
Protein: 14gms
Calories. 400 kcal

Hyderabad mix: Another popular and effective recipe, straight out of a grandmother’s recipe book!
Whole wheat (40g) + Bengal gram powder (16g) + Groundnuts (10g) + Jaggery (20g) . This will provide around
Calories: 330 kcal
Protein: 11.3 gms

Other recipes that can be tried based on your staples

Besan Panjiri
: A mix of 1 part each Bengal gram powder, wheat flour with jaggery and ghee. made into a
One 100gm ball provides:
Protein: 9gm
Calories: 500 kcal

Shakti Aahar: 40g roasted wheat, 20g roasted gram, 10g roasted peanuts, 30g jaggery
Protein : 11.4g
Calories : 394 kcal

What is iron deficiency anaemia?
Iron is a mineral that babies and children need for good health and development. Red blood cells contain hemoglobin, a protein that carries oxygen to all cells in the body. Our bodies need to make iron to make hemoglobin. When you don’t have enough iron, red blood cells become small and pale. They can’t carry enough oxygen to organs and muscles. This is called anaemia.
What are the medical lines for managing nutritional deficiencies?
The nutritional deficiencies treatment depends on the type and severity of the deficiencies. Consulting a physician is important to bridge the gaps caused by lack of nutrients. With correct treatment plan and correct diet plan symptoms usually disappear in time. What are food allergies?
Food allergy happens when a person’s immune system treats a substance (allergens) like an inappropriate invader.

How do I know if my child is allergic to certain foods?
  • Itchy mouth and throat when eating certain foods.
  • Hives (raised red, itchy bumps on the skin)
  • Stomach trouble (diaarohea, cramps, nausea, vomiting)
  • Swelling of face or tongue
  • Trouble breathing
How do I know if my child is lactose intolerant?
Lactose intolerance happens when the body doesn’t produce enough of the enzyme lactase to fully break down the sugar (lactose) found in most dairy products. It is rare in young children and usually only develops after 3 years of age. While some young children adjust to the lack of this enzyme, in many others it may persist for longer periods.

You can give the calcium that the child requires by offering lactose-free or lactose-reduced milk. While none of these provide enough calcium on their own, you can also provide

  • Fortified soy milk
  • Yogurt
  • Orange juice
  • Broccoli
  • Almonds
  • Ragi

There may not be adequate intake of vitamin D, so supplements of Vitamin D maybe be given in consultation with your physician

What is PICA and what does it signify?
PICA is the persistent eating of non-nutritious substances that is often seen as a sign of nutritional deficiency and can be potentially harmful to the child. It is extremely common to see young children ingesting non-food items in the mouth such as sand. Usually there is no harm in trying as children are inquisitive and curious by nature. However, in children having the PICA disorder, curiosity leads to compulsion.

Commonly eaten items include sand, ice, paint flakes, glue, chalk, powders, soap. The more dangerous ones include glass, stones, metal objects, faeces etc.

It is considered a sign of nutritional deficiency in children, especially iron, calcium or zinc deficiency. This maybe an indirect result of several underlying causes such as worm infestation, developmental disorders or psychosocial concerns.

What is the treatment for PICA? Can this be reversed?
For some children, alleviating PICA behavior is relatively a simple process; but for some severe PICA symptoms, a professional advanced approach is required. If the symptoms persist beyond a month please do report to your paediatrician at the earliest. Patience is required from parents to deal with children with PICA.

How do I as a parent deal with a child with PICA?
  • Increase communication skills with your child.
  • Develop a PICA box full of edible items that your child can choose from, instead of his “go-to” substance.
  • Practice positive reinforcement when your child avoids PICA.


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