Management of Malnutrition in Children Under Five Years
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