Management of Malnutrition in Children Under Five Years

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Management of Severe Acute Malnutrition in Children Under Five Years

Ready-to-Use Therapeutic Food (RUTF)

• Local production of RUTF
• Commercial pre-packed Plumpy'Nut

Here is a short training video on the RUTF appetite test (following the WHO guidelines)

Community-based management of severe acute malnutrition: Assessing Appetite
 

Local production of RUTF

There are four basic ingredients in RUTF:

• Sugar
   
• Dried Skimmed Milk
   
• Oil
   
• Vitamin and Mineral Supplement (CMV)

In addition, up to 25% of a product's weight can come from oil-seeds, groundnuts or cereals like oats.

As well as containing the necessary proteins, energy and micronutrients, RUTF should also have the following attributes:

• Taste and texture suitable for young children
   
• No need for cooking before consumption
   
• Resistant to contamination by micro-organisms and long shelf-life without sophisticated packaging. Product should be oil-based

WHO/UNICEF/WFP/SCN DRAFT specifications for RUTF

Ready-to-Use Therapeutic Food

High energy, fortified ready to eat food suitable for treatment of severely malnourished children.

This food should be soft or crushable, palatable and easy for children to eat without any preparation. At least half of the proteins contained in the product should come from milk products.

Commercial Pre-packed Plumpy'Nut

Plumpy'Nut is a ready-to-use therapeutic spread produced by Nutriset and presented in individual sachets. It is a paste of groundnut composed of vegetable fat, peanut butter, skimmed milk powder, lactoserum, maltodextrin, sugar, mineral and vitamin complex.
 

Benefits and composition of Plumpy'Nut

• The quantity distributed to each child is easy to calculate based on the weight
   
• One simply needs to open the sachet by cutting one corner and eat the paste
   
• No preparation or cooking is necessary
   
• Does not need to be diluted with water. This eliminates risk of contamination
   
• Can be used at home with supervision from the health centre
   
• Reduces length of stay in hospital or Therapeutic Feeding Centre
   
• Reduces number of staff necessary for preparation and distribution of therapeutic food
   
• Has a faster recovery rate and higher acceptability than F100
   
• Can be stored at room temperature for long periods of time
   
• Has a long shelf life, even without refrigeration (24 months)

Nutrients and Energy Composition of Plumpy'Nut

Management of Plumpy'Nut

Who should receive Plumpy'Nut?

A child over six months and/or an adolescent according to the following criteria:

• Severely malnourished without medical complications, have passed the appetite test, and have been enrolled in outpatient care.
   
• HIV positive, moderately malnourished without medical complications, have passed the appetite test, and have been enrolled in outpatient care.
   
• Can drink liquids.
   
• Not allergic to milk or nuts.

What should be the dosing for Plumpy'Nut be?

The number of packets per day to be given to a child/adolescent depends on the weight of the child. The table below provides the accurate dosing based on the weight range of the child/adolescent:

How should Plumpy'Nut be administered?

• The Plumpy'Nut should be given to the child in small amounts and frequently (e.g. ½ sachet * 8 times per day) provided that the daily amount is according to prescription.
   
• Always have safe drinking water nearby whenever the child is eating Plumpy'Nut.
   
• Make sure that the child consumes and finishes the Plumpy'Nut before eating their porridge.
   
• A family food meal can be gradually introduced as the child's health improves.
   
• Children should be supervised while they consume their Plumpy'Nut and meals.

Allergic Reaction to Plumpy'Nut:

Although it is unlikely, there is a small chance of a child having an allergic reaction to the peanut butter in Plumpy'Nut. It is important to ask for a history of allergy to the ingredients in Plumpy'Nut.

The allergy may cause reactions in the form of:

• Skin changes: hives, rashes and infections
   
• Body swelling
   
• Shortness of breath
   
• Anaphylactic shock

If the child develops any of these symptoms, discontinue administering Plumpy'Nut. The child should be treated for allergic reaction in the nearest health facility immediately.

Messages for caregivers on Plumpy'Nut

Plumpy'Nut

• Is only for malnourished children and should not be shared with other members of the family who are hungry.
   
• Should be kept  in a secure place and out of reach of children in the house. It should be kept away from the sun to preserve nutrients.
   
• Should be given soon after a feed if the child breastfeeds.
   
• Should always be given before any other family food.
   
• Should be given to the child in small amounts and frequently.
   
• After eating, the remaining amount in the sachet should be kept for the next feed. The top of the sachet should be rolled down for safety.
   
• May cause chocking. Therefore, a generous amount of clean water must always be given to the child, at least 1 cup (100ml) of clean water for each dose of Plumpy'Nut. If choking persists the child should be taken to the nearest health facility.
   
• A balanced, nutritious meal can be given after the correct amount of Plumpy'Nut.
   
• May cause complications such as diarrhoea, vomiting, fevers, swelling, rashes, hives, skin infections, and shortness of breath or shock. If these symptoms are present, the caregiver must stop giving Plumpy'Nut and take the child to the OTC or nearest health facility.
   
• Empty sachets should be kept and presented at each bi-weekly visit.

11 April, 2013