Rehabilitating the severely malnourished infant and child.

The failure of public health measures to control protein-energy malnutrition means that continued therapeutic, curative programs for the rehabilitation of severely malnourished infants and children will be needed for the foreseeable future. Successful rehabilitation requires an understanding of the biology of malnutrition and of the dietary guidelines for provision of appropriate formulas. It is important to recognize that protein-energy malnutrition represents a metabolically and physiologically adapted state but that full recuperation entails compensatory weight gain for recovery of the expected weight for height and body composition. Overzealous early feeding is to be avoided; protein- and energy-rich diets must be introduced gradually and sustained to provide the nutrients necessary for rapid catch-up growth. Therapy involves a three-stage process of addressing acute problems, restoring nutrient balance, and ensuring nutritional rehabilitation. Despite intestinal changes due to malnutrition, intact milk provides a suitable protein source for formulation of recovery diets. As long as protein-energy malnutrition remains prevalent, research to improve its treatment will remain a high investigative priority.