Management of Malnutrition in Children Under Five Years

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Management of Severe Acute Malnutrition in Children Under Five Years

In-patient Treatment Phase 1

2) Transition Phase

Use only F100 formula

Summary of key steps for Transition Phase:

• Daily surveillance of the child remains exactly the same in Transition phase as it was in Phase 1. The expected rate of weight gain is about 6g/kg/day if all the food is taken by the patient and there is not excessive malabsorption.
   
• Breastfeeding children should always get the breast milk before the diet and on demand.
   
• Preparation of feeds
   
  • Amounts of F100 given during the Transition Phase are based on class of weight (Kg)
     
  • Frequency of feeds should normally be 6 per day.
     
  • Use the WHO Feeding Table
     
  • Preparation of feeds: Pre-packaged F100 or On-site prepared F100
     
  • Organization of feeds: Daily instructions need to be left for the staff in charge of preparing and distributing the 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.
     
• Routine antibiotics should be continued after transferred from Phase 1 for another four days.
   
• Move the child back to Phase 1:
   
  • If the child gains weight more rapidly than 10g/kg/day.
     
  • If there is increasing oedema
     
  • If child suddenly develops oedema
     
  • If liver size increases rapidly
     
  • If child develops signs of fluid overload
     
  • If child develops signs of abdominal distension
     
  • If child gets significant re-feeding diarrhoea so there is weight loss
    
    Note: Several loose stools without weight loss is not a criterion to move the child back to Phase 1
     
  • If naso-gastric tube is needed
     
  • If complication arise that necessitates an intravenous infusion
     
• Progress the child to Phase 2:
   
  • If child has a good appetite. Taking 90% of the prescribed F100.
     
  • If child has lost the oedema entirely.

Job aids (Transition Phase):

• Table for F100 amounts to be given during Transition Phase

11 April, 2013