Health, Nutrition, Hygiene and Safety
What this domain tests
This domain tests feeding norms, nutrient needs, growth monitoring and malnutrition classification, the immunisation schedule, hygiene routines, and safety and first-aid decisions for children under six.
Core rules
- Feeding. Exclusive breastfeeding to 6 months, complementary foods from 6 months alongside continued breastfeeding to 2 years. No honey under one year (botulism risk), no added salt or sugar for infants, no whole nuts or grapes under four (choking).
- Meals. A hot cooked meal plus snacks for 3–6 year olds; include a cereal, pulse, vegetable, fat and a vitamin A-rich source. Avoid packaged snacks and sweetened drinks.
- Growth monitoring. Plot weight-for-age and height-for-age. Mid-upper arm circumference 11.5–12.5 cm suggests moderate acute malnutrition; below 11.5 cm suggests severe acute malnutrition and needs urgent referral.
- Immunisation. BCG, oral polio and hepatitis B at birth; pentavalent at 6, 10 and 14 weeks; measles-rubella at 9 months; boosters and vitamin A from 9 months, with vitamin A repeated six-monthly to five years.
- Hygiene. Handwashing before eating and after toilet use, supervised diapering on a fixed surface, daily cleaning and sun-drying of toys, safe drinking water, covered waste bins, food handlers with clean nails and hair covered.
- Safety and first aid. Store medicines locked, cap water containers and buckets, guard stairs and windows, keep hot food out of reach, know emergency numbers (108 ambulance, 1098 Childline). For choking, use back blows and chest thrusts for infants; never give ipecac or toothpaste on burns - cool with running water.
Worked example
A two-year-old has MUAC 11.8 cm and has gained no weight in two months. Reasoning: the value falls in the 11.5–12.5 cm band, so this is moderate acute malnutrition with faltering growth. Action is not to wait and re-measure next term. Refer to the anganwadi or Nutrition Rehabilitation Centre, start supervised food supplementation, screen for illness such as diarrhoea or worms, counsel the family, and re-measure in a fortnight with a dated entry.
Traps that cost marks
Honey or water under six months; adult ORS dilution; treating a burn with toothpaste or oil; confusing severe and moderate MUAC cut-offs.