Exploring swallowing, feeding and communication characteristics of toddlers with severe acute malnutrition.

Only three toddlers were studied, all selected from cases presented at one hospital ward, so the findings cannot be generalised to other toddlers with severe acute malnutrition. The study was cross-sectional and descriptive, so it cannot show that severe malnutrition caused the feeding or language problems, or how these changed over time. All three toddlers also had HIV and TB and were receiving nutritional rehabilitation, anti-retroviral therapy, TB medication and physiotherapy, so the contribution of any single factor or treatment cannot be separated. No hospital speech-language therapy assessment had been done at the time of data collection, and no instrumental swallowing assessment was reported. Hearing status was not fully established. Mothers reported no newborn hearing screening, and participants with recurrent ear infections were discharged before hearing screening could be conducted. Developmental milestones and feeding practices were partly based on parent report and medical files. Mothers had to speak English to answer background questions, so families who speak other languages may be underrepresented. The children were already in the rehabilitation phase and medically fit, so findings may not apply to acutely ill toddlers with severe acute malnutrition.

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Do not conclude that severe acute malnutrition alone caused these feeding and language problems, or that speech-language therapy would fix them. The children also had HIV and TB, were receiving nutritional and medical rehabilitation and physiotherapy, and only three cases were described. This is a description, not evidence that any treatment works.