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ગુજરાતી: ગુજરાતી
हिंदी: बच्चों में कुपोषण: कम वज़न, ठिगनापन और “छिपी भूख”, पहचान, कारण और आयुर्वेदिक पोषण देखभाल
Five-year-old Aryan came from a well-off city family: an expensive school, toys, everything. But he weighed only 13 kg, was short for his age, kept catching colds and diarrhoea, felt tired and could not concentrate on studies. His parents believed, “Our son is just naturally thin.” When we looked at his daily food, it was biscuits and milk in the morning, noodles or bread-jam in the tiffin, chips and juice in the evening and a little dal-rice at night. Almost no dal, vegetables or fruit. Tests showed haemoglobin of 9, low vitamin D and worms in the stool. This was malnutrition, caused not by a lack of food but by a lack of nutrition. With deworming, iron, balanced home food with ghee, dal, vegetables and fruit, outdoor play and Ayurvedic Agni-kindling and strengthening care, Aryan gained 4 kg and 7 cm in one year, and stopped falling ill so often.
Malnutrition means an imbalance of the energy, protein, vitamins and minerals the body needs. Mostly it is a deficiency (undernutrition), but excess (obesity) is also a form of malnutrition. In children, undernutrition has three main forms: underweight (low weight for age), stunting (low height for age due to long-term malnutrition) and wasting (very low weight for height, recent or acute malnutrition). In addition, a deficiency of micronutrients such as iron, vitamins A and D, zinc and iodine, even when the stomach is full, is called “hidden hunger“. Even today, malnutrition in children under five is a major health problem in India. In Ayurveda, childhood malnutrition is understood through Bala Shosha, Karshya (emaciation) and Phakka Roga described in Kashyapa Samhita (weakness and delayed walking due to lack of nourishment), at the root of which lie Agnimandya (weak digestive fire) and Rasa Dhatu Kshaya (depletion of the first body tissue).
Key Takeaways
- Malnutrition occurs in urban, well-off families too, because of junk food and poor nutrition.
- Early detection with a growth chart (weight, height) is the most important step.
- The first 1000 days (pregnancy to 2 years) are the golden window for nutrition.
- Ayurveda: kindling agni, nourishing rasa dhatu, brimhana foods like ghee, milk and dal, bala chaturbhadra, ashwagandha, shatavari, chyawanprash and abhyanga are effective in opening appetite, increasing weight and height and preventing malnutrition from returning; along with control of infections and worms and the doctor’s treatment when needed.
Symptoms of Malnutrition
- Weight not increasing or decreasing; a falling line on the growth chart
- Height low for age
- Thin arms and legs, visible ribs, a dried-up face
- Tiredness, no interest in play, irritability
- Frequent infections, colds, diarrhoea, pneumonia
- Pallor (anaemia)
- Thin, brittle hair, change in hair colour
- Dry skin, cracks at the corners of the lips
- Slow healing of wounds
- Night blindness (vitamin A deficiency)
- Late teething, weak bones
- Delayed development: sitting, walking, speaking
- Poor attention and memory, effect on learning
- In severe malnutrition: swelling of the feet and face (kwashiorkor), extreme wasting (marasmus), hospital treatment needed
The Growth Chart: The Most Important Tool
Measure the child’s weight and height regularly and record them on the WHO/IAP growth chart: every month or two until age 2, then every 3 to 6 months. The direction of the line matters more than a single measurement: is the child growing steadily along their own line or dropping below it? Growth charts are available at the anganwadi, with the paediatrician and in the “Mamta card” or vaccination card. In children aged 6 months to 5 years, mid-upper arm circumference (MUAC) also gives a quick signal: less than 11.5 cm means severe malnutrition, needing immediate treatment.
Causes
Modern View
- Malnutrition of the mother during pregnancy, a low birth weight baby
- No breastfeeding or stopping it early; exclusive breastfeeding is needed for the first 6 months
- Complementary feeding started late or inadequate at 6 months, staying on milk alone for too long
- Frequent infections: diarrhoea, pneumonia, worms; appetite falls and nutrients are lost (the “infection-malnutrition cycle”)
- Junk food: calories, yes; nutrition, no
- Too much milk: kills appetite and lowers iron
- Unsafe water, open defecation
- Poverty, food shortage
- Lack of awareness among parents
- Medical causes: heart or kidney disease, tuberculosis, celiac disease, thyroid problems, poor absorption of food
- The child eating too little, wrong eating habits (separate article)
Ayurvedic View
- Agnimandya: the food is there, but it is not digested and Rasa is not formed.
- Rasa Dhatu Kshaya: if the first tissue itself is weak, the following tissues (Rakta, Mamsa, Meda, Asthi) also become weak.
- Stanya Dushti or absence: the mother’s milk is too little or vitiated (described in detail by Kashyapa).
- Krimi (worms): absorb the nourishment.
- Repeated illness: depletion of tissues.
- Unwholesome diet: dry, too little, incompatible, irregular.
- Unwholesome diet of the mother during pregnancy: affects the child’s basic strength.
Ayurvedic Understanding
According to Ayurveda, food is digested by Agni → Rasa Dhatu → successively Rakta, Mamsa, Meda, Asthi, Majja, Shukra, and their essence, Ojas (immunity, strength). In a child the tissues are “immature” and growing, so nourishment is needed constantly. If Agni is weak, however much you feed, Rasa will not form and Ama (undigested residue) will form instead. That is why, in malnutrition, Ayurveda first focuses on Agni, then on nourishment. Charaka considered Karshya (emaciation) even more worrying than excessive obesity, because strength and immunity fall.
Kashyapa Samhita describes Phakka Roga: when the mother’s milk is too little or vitiated, or the mother becomes pregnant again and the child’s nourishment falls, the child becomes weak, walks late, has a big belly and thin limbs. This shows a remarkable similarity to modern malnutrition.
Samprapti (pathogenesis): inadequate or unsuitable food + Agnimandya + worms or infection → Rasa Dhatu Kshaya → gradual depletion of all tissues and of Ojas → emaciation, weakness, repeated illness, developmental delay.
Samprapti Vighatana (breaking the pathogenesis): treat infections and worms → kindle Agni and digest Ama → gradually introduce Brimhana (nourishing) food → strengthening and Rasayana medicines → daily routine (sleep, play, oil massage) → regular growth assessment.
Classical References
- Kashyapa Samhita, Chikitsa Sthana, Phakka Chikitsa (chapter level).
- Charaka Samhita, Sutra Sthana, Chapter 21, Ashtauninditiya: Karshya (extreme thinness) and its treatment.
- Charaka Samhita, Sutra Sthana, Chapter 22, Langhana-Brimhaniya.
- Charaka Samhita, Chikitsa Sthana, Chapter 15, Grahani: Agni and tissue nourishment.
- Charaka Samhita, Sharira Sthana, Chapter 8, care of the child, wet nurse, breast milk.
Necessary Tests
- Growth chart, weight, height, MUAC, head circumference (in young children)
- CBC, ferritin, anaemia
- Stool test for worms and giardia
- Urine test for hidden infection
- Vitamin D, calcium
- If needed: TSH, celiac and tuberculosis tests, protein-albumin
- Developmental assessment, milestones
The First 1000 Days: The Most Important Time
The 1000 days from pregnancy until the child turns 2 are the fastest period of brain and body development. Malnutrition at this time, stunting and reduced learning ability, mostly cannot be fully reversed later.
- Pregnancy: good nutrition for the mother, iron-folic acid-calcium, regular check-ups, Ayurvedic Garbhini Paricharya (antenatal care).
- First hour after birth: start breastfeeding; the first thick milk (colostrum) is the “first vaccine”.
- 0 to 6 months: breastfeeding only; no water, no ghutti, no honey, no other milk.
- At 6 months: start complementary food, with breastfeeding continued for 2 years or more.
- 6 to 24 months: different food groups every day, thick (not watery), with ghee added, frequently.
Complementary Feeding After 6 Months: The Right Way
- 6 to 8 months: 2 to 3 times a day; mashed khichdi, not dal water but rice mashed with dal, ragi porridge, mashed banana, apple or papaya; start with 2 to 3 spoons and increase.
- 9 to 11 months: 3 to 4 times plus 1 to 2 snacks; slightly grainy texture; upma, dalia, idli, boiled vegetables.
- 12 to 24 months: family food (less spicy), 3 to 4 meals plus 2 snacks a day.
- In every meal: half to one spoon of ghee or oil to increase energy.
- 8 food groups: grains; dal and pulses; milk and curd; eggs or meat (in non-vegetarian families); vitamin A rich fruits and vegetables (carrot, papaya, mango, spinach); other fruits and vegetables; ghee and oil; seeds and dry fruits (powdered). At least 5 every day.
- Before 1 year: no salt or sugar, no honey, cow’s milk not as the main drink.
- No bottle; bowl and spoon; cleanliness.
Useful Ayurvedic Medicines / Formulations (in the child dose decided by the Vaidya)
The right medicine, dose, vehicle (Anupana) and timing are decided by the Vaidya according to the person’s constitution, age, other illnesses and current medicines. In children the dose is much lower, according to age and weight.
- Bala Chaturbhadra Churna: kindles Agni; indigestion and loss of taste in children.
- Ashwagandha: strengthening, nourishing; as Ashwagandha Ghrita or milk preparation (in older children, Vaidya’s dose).
- Shatavari: nourishing; also for increasing breast milk in nursing mothers.
- Chyavanprash / Drakshavaleha: Rasayana, improves taste and immunity (after 3 years).
- Dhatri Lauha / Mandura preparations: in anaemia; only on the Vaidya’s advice and coordinated with the doctor’s iron treatment, as excess iron is dangerous for children.
If worms are present, treat them first (separate article). Market “weight gain” powders and tonics often contain a lot of sugar, and some contain steroids or appetite stimulants; do not use them without a doctor’s or Vaidya’s advice. Balanced home food is better than any powder.
Gradual Ayurvedic approach: If the doctor has given iron, vitamins or deworming medicine, Ayurvedic treatment starts alongside it, without stopping anything. First agni deepana with formulations like bala chaturbhadra, then brimhana food like ghee, milk, dal and ragi, ashwagandha, shatavari, chyawanprash or drakshavaleha in child doses, dhatri lauha for deficiency, daily abhyanga, and play in the sun. When appetite, weight and reports improve, the doctor slowly stops the supplements, and then nourishing home food, abhyanga and seasonal rasayana prevent malnutrition from returning (apunarbhava). In severe malnutrition (swelling, marked lethargy), hospital first.
Nutrition from Home Food: Energy-Dense, Nourishing Dishes
- Moong-rice khichdi with ghee, with vegetables added
- Ragi porridge or sheera with jaggery and ghee; calcium and iron
- Sattu (roasted gram flour) in milk or buttermilk
- Thepla or chilla of moong, bajra or jowar with fenugreek or spinach
- Roasted chana with jaggery, sesame-jaggery chikki, peanut-jaggery (whole peanuts after age 5)
- Dry fruit powder: almonds, walnuts, cashews in khichdi, sheera or milk
- Curd and buttermilk, during the day
- Paneer, eggs (in non-vegetarian families): excellent protein
- Banana, chikoo, mango, papaya, amla, guava, according to season
- Sprouted pulses, boiled
Reduce: biscuits, chips, noodles, bread-jam, chocolate, cold drinks and packaged juice; they fill the stomach but do not nourish. Milk after age 2: up to 400 to 500 ml a day.
Daily Routine
- Regular meal times, no junk snacks in between
- One hour of outdoor play daily for appetite, bones and vitamin D
- Enough sleep for age; growth hormone is produced more during sleep
- Abhyanga: massage with sesame or Bala oil daily or 3 to 4 times a week, followed by a lukewarm bath; in Ayurveda this has special importance for a child’s strength and growth
- Handwashing, clean water, toilets; fewer infections
- Deworming every 6 months (as advised), vitamin A (as per the government programme)
- All vaccines on time
- Limited screen time
Government Support
At the anganwadi centre (ICDS), children’s weight and height measurement, supplementary nutrition (take-home ration or hot meals), vaccination and nutrition counselling for mothers are free. Make full use of the midday meal at school (PM POSHAN), iron-folic acid tablets (Anaemia Mukt Bharat) and National Deworming Day. In severe malnutrition, free treatment is available at the Nutrition Rehabilitation Centre (NRC) of government hospitals.
The Parents’ Mind
A child’s low weight brings worry, guilt and questions from society (“Why is he so thin?”). Force-feeding does more harm (separate article, “My child does not eat”). On the other hand, ignoring a falling line on the growth chart by saying “everyone in our family is thin” is also wrong. A balanced approach: regular measurement, nourishing home food, patience and tests when needed.
According to Season
Winter: Agni and appetite are highest; nourishing food, sesame-jaggery, ghee, gond and dry fruits (according to age), oil massage; the best time to gain weight. Monsoon: Agni is weak and infections are more common; light, fresh food and boiled water. Summer: appetite is low; fluid and nourishing foods such as buttermilk, sattu, fruit and khichdi.
According to Prakriti (Constitution)
- Vata Prakriti: naturally thin, irregular appetite, constipation; ghee, milk, warm unctuous food, regular timings, oil massage. These children are often “thin but healthy”; the growth chart decides.
- Pitta Prakriti: good appetite, digests quickly; frequent nourishing meals.
- Kapha Prakriti: usually chubby; malnutrition is less common, but “hidden hunger” (iron) is possible.
Common Myths
- “Malnutrition happens only among the poor”: wrong; junk food causes it in city children too.
- “Chubby means healthy”: wrong; obesity is also malnutrition, and hidden hunger is possible.
- “Milk alone is enough nutrition”: wrong; after 6 months varied food is needed, and too much milk increases anaemia.
- “Thin dal water is nourishing”: wrong; thick food is needed.
- “Weight gain powder is the solution”: home food is best.
- “Height is only genetic”: partly; nutrition and infections also play a big role.
Precautions
- Swelling of the feet or face, extreme wasting, refusing food, lethargy: severe malnutrition; go to the hospital or NRC immediately.
- Iron or Lauha medicines only after tests and in the right dose; too much is toxic.
- No whole peanuts, chana or raisins for children under 5 because of choking; give pieces or powder.
- Be careful with advertised weight gain products.
Do’s and Don’ts
Do: growth chart, exclusive breastfeeding for 6 months, thick complementary food at 6 months, ghee-dal-vegetables-fruit, treatment of worms and infections, oil massage, play, vaccination, anganwadi benefits.
Don’t: junk food, too much milk, watery food, bottles, force-feeding, ignoring a falling line on the chart, tonics or powders on your own.
Case Studies
Case 1: Urban “hidden hunger”
5 years; low weight and height, no appetite, frequent infections; lots of junk food; haemoglobin 9, low vitamin D, worms. The doctor gave deworming and iron and vitamin D. In Ayurvedic terms, agnimandya with rasa dhatu kshaya; the vaidya gave bala chaturbhadra, vidanga, dhatri lauha and chyawanprash in child doses, ghee-rich home food, chana-jaggery in the evening, no junk, daily abhyanga and play in the sun. Within two weeks appetite opened up; at three months haemoglobin was normal and the doctor stopped the supplements; within a year 4 kg weight and 7 cm height gained, and far fewer infections. (Results may vary from person to person.)
Case 2: Late complementary feeding
11 months; only on milk from a bottle, weight 6.5 kg, late sitting; under the pediatrician’s observation. The vaidya taught the mother the right way of complementary feeding: mashed khichdi with ghee, ragi porridge, mashed fruit, four times a day; along with bala chaturbhadra in a child dose for agni, daily infant abhyanga and registration at the anganwadi. Within six months weight was 8.8 kg, sitting and standing came on time, and growth then stayed on track with nourishing home food. (Results may vary from person to person.)
Case 3: Severe malnutrition: hospital first
2 years, labourer’s family; repeated diarrhoea, swollen feet, marked lethargy. Admitted at once to the government hospital’s nutrition rehabilitation centre for special treatment. After discharge the vaidya gave low-cost nourishing foods (sattu, ragi, moong, jaggery-chana), agni deepana, clean water and hygiene to prevent diarrhoea, daily massage and ashwagandha-shatavari in child doses; anganwadi nutrition continued. Within three months weight rose steadily, diarrhoea stopped, and the child began to play and talk. This case shows the importance of both government services and Ayurvedic care afterwards. (Results may vary from person to person.)
When to See a Doctor Immediately (Red Flags)
- Swelling of the feet or face
- Extreme wasting, loose skin
- Refusing food and drink, lethargy
- No weight gain or weight loss for 2 to 3 months
- Repeated diarrhoea or pneumonia
- Night blindness, dry eyes
- Clear developmental delay
About Dr. Nikul Patel
Dr. Nikul Patel (BAMS) is an Ayurvedic physician at LifeCare Ayurveda and has been practising since 1999, that is, for 27 years. In childhood malnutrition and Karshya, he works in coordination with the paediatrician and gives practical guidance through growth assessment, Agni kindling, planning of nourishing home food, oil massage and strengthening Rasayana in child doses.
FAQs
How do I know if my child is malnourished?
Weight and height on the growth chart, MUAC, and symptoms such as tiredness, pallor and frequent infections.
How can I increase my child’s weight?
Balanced home food with ghee, regular meal times, no junk, treatment of worms and infections, play and sleep.
What is hidden hunger?
A deficiency of micronutrients such as iron, vitamins A and D and zinc, even when the stomach is full.
When should complementary feeding start?
At 6 months, continuing breastfeeding; thick and varied food.
Does Ayurveda help in malnutrition?
It supports through Agni kindling, nourishing diet, oil massage and strengthening medicines in child doses; in severe cases hospital treatment comes first.
People Also Ask
What is stunting?
Low height for age due to long-term malnutrition.
What is MUAC?
Mid-upper arm circumference, a quick sign of malnutrition from 6 months to 5 years.
Why are the first 1000 days important?
From pregnancy to 2 years, the brain and body develop fastest.
What is Phakka Roga?
Described in Kashyapa Samhita: a child’s weakness and delayed walking due to lack of nourishment.
What is an NRC?
Nutrition Rehabilitation Centre, free government treatment for severely malnourished children.
Conclusion
Malnutrition is often not visible, but it deeply affects a child’s growth, immunity and future. Along with early detection on the growth chart, nutrition in the first 1000 days and control of infections and worms, Ayurveda can be the main path: agni deepana, brimhana foods like ghee, milk and dal, bala chaturbhadra, ashwagandha, shatavari and chyawanprash in child doses and daily abhyanga open appetite, increase weight and height, reduce the need for supplements and prevent malnutrition from returning; in severe malnutrition, hospital first. Every child’s results may differ.
Dr. Nikul Patel (B.A.M.S.)
307, 3rd Floor, Shalin Complex, Above Farki Lassi, Krishnabaug Char Rasta, Maninagar, Ahmedabad – 380008
Timings: 10:00 AM to 1:00 PM and 3:00 PM to 6:30 PM | Saturday–Sunday: Closed
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