Although ICDS provides for “double ration” for malnourished children under 5 years, this has neither yielded the desired results nor enabled to have adequate followup of the malnourished children. Therefore guidelines have been issued for identifying malnourished children upto 5 years by “weight for age” criteria, by   “weight for height” criteria and by presentation of “bilateral pitting oedema” and to take “Special care and Supervised feeding” of such children.     These guidelines are as follows:

• Children upto 5 years will be identified as Severely Underweight (SUW) as per the “weight for age” criteria and will be identified as Severe Acute Malnutrition (SAM)/Moderate Acute Malnutrition (MAM) as per the “weight for height” criteria. However children below 6 months who are SUW are automatically SAM and their height need not be measured. Also all children upto 5 years who have nutritional oedema (bilateral pitting oedema) are SAM and their weight and height need not be recorded.
• For such identification, Anganwadi workers (AWWs) will record weight of children once in a month and will measure their height once in 3 months. Based on the “weight for age” criteria, the AWW will plot the weight for each child in the growth monitoring register and will categorize the child as Severely Underweight (SUW)/ Moderately Underweight (MUW) / Normal, if the graph for the child is in red zone, yellow zone or green zone respectively. Based on “weight for height” criteria, the AWW will use the “Reference Card” and if for a particular height the weight of the child is low/too low, the child is categorized under MAM/SAM.
• All children upto 6 months categorized as SUW (automatically SAM too) will be examined by Medical Officer (PHC) [MO(PHC)] and will compulsorily be referred to the Nutrition Rehabilitation Centre (NRC).  In the meanwhile, the mother of such a child will be encouraged to continue exclusive breastfeeding.
• All children upto 5 years who have nutritional oedema (bilateral pitting oedema) (automatically SAM too) will be examined by MO(PHC) and will compulsorily be referred to the NRC. In the meanwhile, supervised feeding will be provided for the child as explained hereunder. 
• All children identified as SUW/ SAM/ MAM upto 5 years will be given “Special care and Supervised feeding”. For this purpose model menus have been separately prescribed for the age groups of 7 months - 3 years and 3-6 years at Table 1 and Table 2 below. As per these menus, SUW/ SAM/ MAM children will be given caloric dense food every 2 hours. Among these feeds, certain feeds (viz of egg, milk and meal + oil) will be given to “7 months – 3 years” and certain feeds (viz of egg, milk, meal +oil, snack, balamrutham) will be given to “3-6 years” at the AWC itself. The AWW will however supervise not only these feeds at the AWC but also the feeds to be given at home.