Mother, Infant and Young Child Nutrition & Malnutrition - Feeding practices including micronutrient deficiencies prevention, control of wasting, stunting and underweight Mother, Infant and Young Child Nutrition & Malnutrition


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Management of Malnutrition in Children Under Five Years

Home  »  Management of Malnutrition in Children  »  Management of Severe Acute Malnutrition in Children Under Five Years  »  Ready-to-Use Therapeutic Food (RUTF)

Management of Severe Acute Malnutrition in Children Under Five Years

Ready-to-Use Therapeutic Food (RUTF)


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.


Nutritional composition
 

Moisture content 2.5% maximum
Energy 520-550 Kcal/100g
Proteins 10 to 12 % total energy
Lipids 45 to 60 % total energy
Sodium 290 mg/100g maximum
Potassium 1100 to 1400 mg/100g
Calcium 300 to 600 mg/100g
Phosphorus (excluding phytate) 300 to 600 mg/100g
Magnesium 80 to 140 mg/100g
Iron 10 to 14 mg/100g
Zinc 11 to 14 mg/100g
Copper 1.4 to 1.8 mg/100g
Selenium 20 to 40 µg
Iodine 70 to 140 µg/100g
Vitamin A 0.8 to 1.1 mg/100g
Vitamin D 15 to 20 µg/100g
Vitamin E 20 mg/100g minimum
Vitamin K 15 to 30 µg/100g
Vitamin B1 0.5 mg/100g minimum
Vitamin B2 1.6 mg/100g minimum
Vitamin C 50 mg/100g minimum
Vitamin B6 0.6 mg/100g minimum
Vitamin B12 1.6 µg/100g minimum
Folic acid 200 µg/100g minimum
Niacin 5 mg/100g minimum
Pantothenic acid 3 mg/100g minimum
Biotin 60 µg/100g minimum
n-6 fatty acids 3% to 10% of total energy
n-3 fatty acids 0.3 to 2.5% of total energy


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.
 

Plumpy'Nut

 

Eating Plumpy'Nut

Plumpy'Nut is specifically designed to treat acute malnutrition without complications and has the following characteristics:
  • It is nutritionally equivalent to F-100 (therapeutic milk used for in-patient care in Phase 2)
     
  • One sachet has an energy value of 500Kcal
     
  • One sachet has a weight of 92 g
     
  • Each carton of Plumpy'Nut contains 150 sachets (around 15.1 kg)

 


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


Nutrient
 

Per sachet of 92 g

Nutrient

Per sachet of 92 g
Energy 500 kcal Vitamin A 840 mcg
Proteins 12.5 g Vitamin D 15 mcg
Lipids 32.86 g Vitamin E 18.4 mg
Calcium 276 mg Vitamin C 49 mg
Phosphorus 276 mg Vitamin B1 0.55 mg
Potassium 1 022 mg Vitamin B2 1.66 mg
Magnesium 84.6 mg Vitamin B6 0.55 mg
Zinc 12.9 mg Vitamin B12 1.7 mcg
Copper 1.6 mg Vitamin K 19.3 mcg
Iron 10.6 mg Biotin 60 mcg
Iodine 92 mcg Folic acid 193 mcg
Selenium 27.6 mcg Pantothenic acid 2.85 mg
Sodium < 267 mg Niacin 4.88 mg


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:


Weight (kg)
 

Packets / day

Packets / w
3.5 - 3.9 1.5 11
4.0 - 5.4 2 14
5.5 - 6.9 2.5 18
7.0 - 8.4 3 21
8.5 - 9.4 3.5 25
9.5 - 10.4 4 28
10.5 - 11.9 4.5 32
12.0-13.5 5 35
>13.5 200kcal/kg/day 200kcal/kg/day


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.

 

Key Message:

Plumpy'Nut is a treatment for malnourished children.  Only the malnourished children should eat it.



26 January, 2014
 


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