Child malnutrition: how to spot stunting and wasting early

Malnutrition means not getting enough of the right food to grow well. In Ethiopia, nearly 4 in 10 children under 5 are shorter than they should be for their age (stunted). Malnutrition weakens the body’s defence against disease — a stunted child is much more likely to die from a common cold or diarrhoea than a well-fed one.

The good news: growth monitoring at the health post catches malnutrition early. Ready-to-use therapeutic foods (RUTF) treat severe cases at home. Prevention works.

On this page

• The two main kinds
• Signs to watch for
• How the health post measures growth
• Feeding well from birth to 2 years
• Treatment — what to expect
• When to go to a health post today

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The two main kinds

Stunting — the child is short for their age. Caused by long-term lack of good food and repeat infections in the first 1000 days (pregnancy + 2 years). Damage to brain development and future height is often permanent.

Wasting — the child is thin for their height. Recent, sudden — usually from illness or a food crisis. Can be treated and reversed, but severe wasting is life-threatening.

A child can be stunted, wasted, or both. Both are measured at every under-5 clinic visit.

Signs to watch for

• Your child looks smaller than other children the same age
• Your child’s clothes still fit long after they should have grown out of them
• Rapid weight loss during or after an illness
• Ribs and hip bones showing clearly
• Loose skin folds on the buttocks or thighs
• Swelling in the feet, legs, or face (this is a specific danger sign — see §Urgent)
• Very pale skin, hair, or lips
• Loss of interest in play; unusually quiet
• Frequent infections that take a long time to get over
• Poor school performance (older children)

Some malnutrition has NO obvious sign. That’s why every under-5 visit includes weight and length measurements — trust the health worker’s judgement even if your child looks fine to you.

How the health post measures growth

Three simple checks:

MUAC (mid-upper arm circumference) — a coloured tape around the upper arm. Under 6 months not used; from 6-59 months:

• Green (>12.5 cm): normal
• Yellow (11.5-12.4 cm): moderate acute malnutrition (MAM) — nutrition support needed
• Red (<11.5 cm): severe acute malnutrition (SAM) — urgent treatment

Weight-for-height — plotted on a growth chart. Below -3 standard deviations is severe wasting.

Height-for-age — plotted on a growth chart. Below -2 standard deviations is stunting.

Bring your child’s growth-monitoring card (“yellow card”) to every visit. Look at the curve — if it drops or flatlines, ask the health worker why.

Feeding well from birth to 2 years

The first 1000 days matter most. Get this right and most malnutrition never happens.

::: doList

Do

• Breastfeed within one hour of birth — the thick yellow first milk (colostrum) is critical
• Exclusive breastfeeding for the first 6 months — no water, no formula, not a sip of anything else
• Start complementary foods at 6 months — thick porridge (genfo), mashed vegetables, egg yolk, small pieces of meat/fish where available
• Keep breastfeeding until at least 2 years old alongside family foods
• Feed 5-6 times a day by age 1 (3 meals + 2-3 snacks)
• Include animal-source foods — egg, milk, small dried fish, meat — even small amounts help
• Use iodised salt in family cooking
• Take the child to every EPI vaccine visit — infections cause malnutrition, vaccines prevent it
• Give vitamin A twice a year at health post (child aged 6-59 months)
• Deworming twice a year from 12 months :::

::: dontList

Don’t

• Do not give water, tea, or porridge before 6 months
• Do not stop breastfeeding when the child gets sick — that’s when they need it most
• Do not give the child watered-down family food only — it fills the stomach without nutrition
• Do not use cooking oil to add “energy” without also adding protein
• Do not accept a growth-chart curve that goes down — ask why and act
• Do not skip vaccinations or vitamin A :::

::: factBox

Ideal complementary food at 6-12 months

Thick enough that a spoon stands up in it. Mix:

• Boiled and mashed vegetables (potato, carrot, pumpkin, kale)
• A protein: mashed egg yolk, milk, small pieces of chicken/fish/lentils
• Small amount of oil for extra energy

Feed with a clean spoon (not straight from an adult’s mouth). Give freshly prepared, do not store more than 2 hours at room temperature. :::

Treatment — what to expect

For moderate acute malnutrition (yellow MUAC), the health post provides:

• Nutrition counselling for the mother
• Fortified blended food (FBF) — “Famix” or similar — for supplementation
• Micronutrient supplements
• Treatment of any underlying infection

For severe acute malnutrition without complications (red MUAC, no danger signs), outpatient treatment:

• Ready-to-use therapeutic food (RUTF) — energy-dense peanut paste, one sachet per day per age
• Weekly weight checks
• Continued breastfeeding
• Treatment of infections

Most children respond in 4-8 weeks. Keep the sachets away from siblings — they’re a specific medicine for the malnourished child.

For SAM with complications (danger signs, not eating, severe swelling): inpatient treatment at a therapeutic feeding centre — usually a district hospital.

When to go to a health post today

::: urgentAdvice severity=“urgent”

Urgent advice: go to a health post today if your child has:

• Sudden weight loss during illness
• MUAC in the red zone
• Swelling in both feet (“bilateral pitting oedema” — kwashiorkor sign)
• Refuses to eat or breastfeed for more than 12 hours
• Persistent diarrhoea alongside poor eating
• Very weak, apathetic, hard to wake

Free treatment. Free RUTF where needed. Do not wait. :::

::: urgentAdvice severity=“emergency”

Emergency: go to a hospital now if:

• Child is unconscious or has a convulsion
• Very fast or difficult breathing
• Not passing urine
• Child’s temperature is below 35.5°C or above 39°C
• Cannot swallow :::

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa

Sources: WHO Malnutrition fact sheet 2024; EPHI EMDHS 2019; Ethiopian MoH National Nutrition Program II.

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Draft notes: ~1100 words · grade 7 · isTimeCritical false but both urgentAdvice severities used · Ethiopian context: MUAC colour zones, RUTF (Plumpy’Nut), CBN programme, “yellow card”, genfo · Placeholder reviewer per B2B-22.