Weaning infants with malnutrition, including HIV.

A normal pregnancy and adequate lactation performance should produce at 6 months of life a healthy baby, who has a weight and height within the limits of international growth norms. When that does not happen and the child is either too small (or too big), i.e. 'malnourished', strong determinants will have been maternal health, combined with environmental stress to the baby. In discussing differential strategies for weaning and complementary feeding, the distinction must first be made between true clinical malnutrition and simply deviant growth. The former needs rehabilitation therapy, which is beyond the scope of this discussion. For deviant poor growth, one must devise a regimen that removes an infant from any low-weight danger zone for increased early mortality risk. Thereafter, one can address the emerging scientific evidence that rapid accelerated catch-up growth has implications for increased metabolic derangement and chronic disease risk in childhood and beyond. Human immunodeficiency virus (HIV), infecting either mother or mother and offspring, is one of the emerging situations that will produce malnutrition before a child is due to be weaned. It will also often induce early weaning. Attention to specific micronutrient supplementation is recommended in HIV-seropositive and malarial infants.