Feeding Sick Children

Introduction
When a child gets sick, it will affect how he or she eats. Different foods may need to be offered until
the child gets better, and more foods need to be offered during recovery. Generally, it is
recommended that a child continue to be fed with foods of their choice throughout an illness, rather
than having his/her foods restricted. This allows the child to continue to meet his/her nutritional
requirements while providing extra nutrients that some illnesses may require for healing.
Why does a sick child need to eat nutritious meals?
A sick child should eat well even if he/she is not active. He/she needs nutrients to fight infections
and replace nutrients that were lost during his/her illness. During illness a child may be too weak to
eat, having trouble swallowing, or finding it difficult to eat because of a cough or blocked nose.
Infection often reduces appetite. It also increases the need for some nutrients if:
 nutrients are poorly absorbed by the gut or
 the body uses nutrients faster than usual (eg to repair the immune system).
If a sick child does not eat enough, his/her own body fat and muscles will be used for energy and
nutrients. He/she will lose weight and become undernourished. Even during a short illness, a child's
growth often falters. The immune systems may become less effective and not be able to fight
infections.
What to feed a sick child?
 During illness the challenge is to continue feeding the child. Sick children frequently reject
food or eat only small quantities of food offered to them. It is important not to withhold foods or
liquids.
 Here are some tips on how to feed children during illness:
 If a child is still breastfeeding, breastfeed more frequently and longer at each feed. If a
breastfeeding infant is too weak to suckle, you can express milk and feed it from a spoon or cup.
 Give frequent small feeds.
 Give nutrient-dense foods that are soft, varied and the child's favorite.
 Give mashed or soft foods if the child has trouble swallowing. However do not dilute foods
or milk.
 Be patient but persistent; offer foods that the child likes to increase appetite.
 Hold the child on your lap or keep him/ her sitting up (Do not feed a child who's lying down;
this can cause choking).
 If a child vomits, wait for ten minutes and continue offering fluids or food after that.
 Do not force a child to eat.
During diarrhea or fever, a sick child often loses or uses more water than usual. Therefore, she
needs plenty of clean and safe drinks. Boiled water, yoghurt drinks and other nutritious liquids
should be given rather than carbonated drinks or cordials.
 A child who is breastfeeding should be breastfed frequently. A child who is not breastfeeding should
be given plenty of liquid to drink every 1-2 hours.
Feeding a child during recuperation
Bear in mind that recuperation takes time. Duration is an important aspect of nutritional care. Extra
attention to feeding should continue for 2 or more weeks following illness. Feeding during
recuperation is critical to help the child “catching up” from the nutritional losses.
During recuperation,
 Children often have hearty appetites and will be eager to eat more food than
usual. Continue to feed the child frequently.
 Children should be encouraged to eat more at every meal, and be given an extra meal each
day (or extra snacks in between meals) for at least two weeks.
 Continue to give nutritious food such as meat, fish, liver, egg, milk, and oil to meet the
requirements for catch-up growth. Extra food is needed until the child regain his/her weight that
was lost during illness and is growing well again.

Feeding a Sick Child, during and after Illness

1. Exclusive breastfeeding (infants 0-6 months)

All lactating mothers are encouraged by a trained service provider to:

 Increase the frequency of breastfeeding during and after illness to limit the weight loss and
speed recovery.
 
 Consult immediately a health worker for all infants with feeding difficulties or with any
condition (including oral thrush)
 
 Not give other fluids, except prescribed medicines. Give ORS for infants with diarrhoea and
provide ZINC supplementation (10 mg) for 10-14 days according to protocol.

2. Complementary feeding (children 6-35 months)

All lactating mothers are encouraged by a trained service provider to:

 Increase the frequency of breastfeeding and offer additional food to limit the weight loss
during illness.
 
 Give one additional meal of foods with high energy and nutrient density each day for the
following two weeks to improve child recovery after illness.
 
 Give ORS for children over 6 months with diarrhoea and provide ZINC supplementation (20
mg)  for 10-14 days according to protocol.

For more information, check energy density of infant foods.

3. Prevention of Mother to Child Transmission of HIV/AIDS

 All HIV positive mothers should be supported on infant feeding in the context of HIV
4. Early detection and referral of children with acute malnutrition

 All mothers should be alerted on the importance to check if the baby is loosing weight during
illness or is not regaining weight after illness. When the child is very young, the abrupt lost of
weight should be regarded as a crisis.
 
 All children over one year or six months with length above 65 cm should be screened
using Mid-Upper Arm Circumference (MUAC) tape if they do not have a previous growth
record in the Child Health Card.

MUAC Resources - Sources for MUAC Straps

 
 All children should be screened for bilateral pitting oedema
 
 Children with suspected acute malnutrition should be promptly referred to sites for admission
and malnutrition treatment. Mothers should be alerted that malnutrition treatment is a life-
saving measure.