Management of Malnutrition in Children Under Five Years
Management of Severe Acute Malnutrition in Children Under Five Years
In-patient Treatment Phase 2
3) Phase 2
Use F100 or RUTF
Summary of key steps for Phase 2:
- Surveillance of the child:
- 3 times per week, weight is measured, entered and plotted on the Multichart.
- 3 times per week, the presence of bilateral oedema is assessed and noted in the Multichart.
- Every morning, body temperature is measured and noted in the Multichart.
- Every morning, standard clinical signs (stool, vomiting, dehydration, cough, respiration and liver size) are assessed and noted in the Multichart.
- Every week, Mid-Upper Arm Circumference (MUAC) is taken.
MUAC Resources - Sources for MUAC Straps
- Every 3 weeks height/length is taken.
- For every feed intake record is noted in the Multichart.
- F100 or RUTF are used in Phase 2. Never give F100 for home use, provide RUTF as take-home therapeutic food. RUTF can be started in the in-patient treatment to assess the tolerance of the child to the product.
- A short training video on the RUTF appetite test (following the WHO guidelines) is also available here.
- Breastfeeding children should always get the breast milk before the diet and on demand
- Preparation of feeds
- Amounts of F100 or RUTF to give during Phase 2 are based on class of weight (Kg)
- Frequency of F100 feeds should normally be 5-6 times per day. One portion of porridge may be given for patients who are more than 8 kg (24 months of age). Frequency of RUTF should be 5-6 times per day. Clean water should be offered to drink while giving RUTF.
- Use the WHO F100 Feeding Table or M. Golden RUTF Feeding Table
- Preparation of feeds: Pre-packaged F100 or On-site prepared F100 and RUTF
- Organization of feeds: Daily instructions need to be left for the staff in charge of preparing and distributing F100 feeds with the required amount for each child. Individual milk cards are a good practice for this. F100 can not be kept in liquid form at room temperature for more than a few hours before it is consumed. RUTF can be kept safely and the amount for several feeds can be given to the patient at one time.
- Children should be able to take as much F100 or RUTF they want if they feed quickly and easily. They must not be force fed.
- Iron needs to be added to the F100 in Phase 2:
- For 2 to 2.4 liters of F100: Add 1 crushed tablet of ferrous sulphate (200 mg).
- For 1 to 1.2 liters of F100: Dilute 1 tablet of ferrous sulphate (200 mg) in 4ml water first then add only 2ml of the solution in the F100.
- For 500-600 ml of F100: Dilute 1 tablet of ferrous sulphate (200 mg) in 4ml water first then add only 1ml of the solution in the F100.
- De-worming tablet (Albendazole) is given at the start of Phase 2 for patients over 1 year.
- Health and nutrition education including cooking demonstrations should be made available on site to show the components of a balanced meal, the cooking time and the consistency of the porridge.
- Move the child back to Transition Phase or to Phase 1:
- If the child develops a significant "re-feeding oedema" (grade ++ or grade +++)
- If the child develops a major illness
- If the child develops "re-feeding diarrhoea" leading to weight loss.
- Move the child to out-patient treatment when:
- There is a good supply of RUTF
- An out-patient treatment service is close to the patient's home
- The child has good appetite and no medical complications
- The caregiver has the motivation and capacity to continue the treatment at home
Note: this is not a "discharge" from the in-patient treatment but a transfer to another part of the same program.
Job aids (Phase 2):
- Table for F100 and RUTF amounts to be given during Phase 2
16 December, 2017