Growth and Developmental Outcomes Following Sensory Stimulation and Structured Play Therapy in Children with Acute Malnutrition: A Prospective Observational Study

Background: Developmental delay is a common but often under-recognized consequence of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). The World Health Organization recommends integrating psychosocial stimulation with nutritional rehabilitation; however, evidence regarding its routine implementation in Nutritional Rehabilitation Centres (NRCs) in India remains limited. The objective is to evaluate the growth and developmental outcomes of children with acute malnutrition receiving routine nutritional rehabilitation along with sensory stimulation and structured play therapy. Material and Methods: This prospective observational study was conducted at the Nutritional Rehabilitation Centre, Department of Pediatrics, Bangalore. Eighty children aged 2–60 months with SAM or MAM were enrolled and followed from admission to six months after discharge. Anthropometric measurements (weight, height/length, and mid-upper arm circumference) and developmental status across gross motor, fine motor, cognitive, receptive language, expressive language, social-emotional, and self-help domains were assessed at admission, discharge, and at 1, 3, and 6-month follow-up visits using the National Centre of Excellence developmental milestone checklist. Statistical analysis included McNemar, and paired t-test. Results: The mean age of participants was 21.22 ± 14.22 months, and 65% were males. Significant improvements were observed in weight, height/length, and mid-upper arm circumference during follow-up (P<0.05). The proportion of children with severe wasting decreased from 51.2% at admission to 3.8% at six months. Developmental delays were most prevalent at admission in the cognitive (88.8%), fine motor (86.3%), and receptive language (82.5%) domains. Progressive improvement was observed across all developmental domains during follow-up, with the greatest improvement noted in gross motor and fine motor development. Two children with persistent developmental delay across all domains were subsequently diagnosed with autism spectrum disorder and referred for specialized care. Conclusion: Significant improvements were observed over the follow-up period among children receiving routine nutritional rehabilitation that included sensory stimulation and structured play therapy. Incorporating caregiver-led developmental stimulation into routine NRC services may facilitate optimal recovery and should be strengthened within facility- and community-based management programs.

Keywords: Severe acute malnutrition; Moderate acute malnutrition; Child development; Play therapy; Rehabilitation, Nutritional; Developmental delay.