Management of Malnutrition in Children Under Five Years

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Management of Severe Acute Malnutrition in Children Under Five Years

Out-patient Treatment Phase 2

Summary of Key Steps for Out-patient treatment:

• Patients from admission that fulfil the criteria for SAM, do not have any medical complications and have passed the appetite test can go directly to Phase 2 and be registered as "new admission". All their information should be recorded in the Client Card [Front | Back] including the target weight for discharge (WHO/NCHS table).
   
• Patients that are admitted directly to Phase 2 as out-patients should be provided with a systematic medical examination and given routine medicine. Note: they will be given the same routine medicines as those provided in Phase 1 as in-patient.
   
• Patients transferred from in-patient treatment should be registered as "transferred from". All their information should be recorded in the Client Card including the target weight for discharge (WHO/NCHS table).
   
• Surveillance of the child:
   
  • Every week, weight is measured, entered and plotted on the Client Card.
    
     
  • Every week, the presence of bilateral oedema is assessed and noted in the Client Card.
     
  • Every week, body temperature is measured and noted in the Client Card.
    
     
  • Every week, standard clinical signs (stool, vomiting, dehydration, cough, respiration and liver size) are assessed and noted in the Client Card.
     
  • Every week, Mid-Upper Arm Circumference (MUAC) is taken.
     
  • Every month or as required height/length is taken.
     
  • Every week, appetite test is done and intake record is noted in the Client Card.
    
     
• RUTF is provided as take-home therapeutic food for malnourished children only. RUTF are usually oil-based with little available water and, therefore, resistant to bacterial growth. This allows them to be safely used at home even where hygiene conditions are not optimal. It is important that caregivers are provided with comprehensive information on the use of RUTF.
   
• The amount of RUTF provided to the caregiver is based on the class of weight and on the necessary quantity required to last until the next visit to the out-patient site.
   
• Use the RUTF Feeding Table
   
• Breastfeeding children should always be given Breast-Milk before the RUTF.
   
• Caretakers should give small and regular meals of RUTF and encourage their children to eat as often as possible (every 3-4 hours). RUTF should not be shared with other family members even if the child does not consume all the diet offered. Leftovers can be kept safely and eaten at a later time.
   
• RUTF is the only food the child needs to recover. It is not necessary to give other foods as they do not have the equivalent of nutrients contained in RUTF and may interfere with the recovery of the child. If other foods are given, always give RUTF before other foods. While giving RUTF, always offer plenty of clean water to drink.
   
• Move the child to Phase 1 (in-patient):
   
  • If the child develops any of the medical complications that demand in-patient treatment.
     
  • If the child has severely reduced appetite.
     
  • If the child increases/develops oedema.
     
  • If the child develops "refeeding diarrhoea" sufficient to lead to weight loss.
     
  • If the child does not respond to the treatment.
     
  • If there is a weight loss for 2 consecutive weighing sessions.
     
  • If there is a weight loss of more than 5% of body weight at any visit.
     
  • If the weight stays static for three consecutive weighing sessions.

Out-patient Treatment Site - What you need at a glance

Resources for Management of Malnutrition in Children Under Five Years  - Out-patient Treatment Outpatient Care of Children with Acute Malnutrition - Trainers' Manual   69 pages 902kb – Republic of Uganda, Ministry of Health Community Therapeutic Care Community-based Therapeutic Care (CTC)  163 pages 1.4mb A Field Manual, First Edition, 2006 Community-Based Management of Severe Acute Malnutrition 8 pages 393kb A Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund Community-based Therapeutic Care CTC  [powerpoint]  5.3mb Steve Collins & Paluku Bahwere - Valid International Community-based Therapeutic Care CTC    20 pages 481 kb Steve Collins - Valid International Community-based Therapeutic Care (CTC) - Special Supplement   56 pages 1.4 mb Compiled and edited by Tanya Khara & Steve Collins, Valid International. The material in this supplement is drawn from research carried out under the CTC research and development programme, a collaboration between Valid International and Concern Worldwide Community-based Therapeutic Care - A new paradigm for selective feeding in nutritional crises     36 pages 2mb - Steve Collins

02 January, 2009