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close this bookGuidelines for the Inpatient Treatment of Severely Malnourished Children (UNICEF - WHO - OMS, 1998, 21 p.)
View the document(introduction...)
View the documentA. General principles for routine care
View the documentB. Treatment of associated conditions
View the documentC. Failure to respond to treatment
View the documentD. Discharge before recovery is complete
View the documentE. Emergency treatment
View the documentAppendix 1: Recipe for ReSoMal oral rehydration solution & electrolyte/mineral solution
View the documentAppendix 2: Recipes for F-75, F-100 and F-135
View the documentAppendix 3: F-75 feed volumes by feeding frequency and body weight
View the documentAppendix 4: Structured play activities

Appendix 4: Structured play activities

Play therapy is intended to develop language skills and motor activities aided by the use of simple toys. It should take place in a loving, relaxed and stimulating environment.

Language skills: At each play session:

· teach local songs and finger and toe games
· get child to laugh and vocalise, repeat what (s)he says.
· describe all activities
· teach action words with activities eg 'bang bang' as (s)he beats a drum, 'bye bye' as (s)he waves etc
· teach concepts at every opportunity, examples are in italics in the text below

Motor activities:

Every day encourage the child to perform the next motor milestone eg:

· bounce the child up and down and hold under the arms so that the feet support child's weight
· prop child up, roll toys out of reach, encourage child to crawl after them.
· hold hand and help child to walk
· when starting to walk alone, give a 'push-along' and later a 'pull-along' toy.

Activities with toys Simple toys can easily be made from readily available materials. These toys can be used for a variety of different motor activities.

'Ring on a string'

· swing ring within reach and tempt child to grab it

· suspend ring over crib and encourage child to knock it and make it swing

· let child explore the ring, then place it a little distance from child with the string stretched towards him/her and within reach. Teach the child to retrieve the ring by pulling on the string horizontally.

· sit child on lap, then holding the string, lower the ring towards the ground. Teach child to get the ring by pulling up on the string vertically. Also teach child to dangle the ring.

'Rattle and Drum'

· let the child explore rattle. Show child how to shake it saying 'shake shake'.
· encourage child to shake the rattle by saying 'shake' but without demonstrating.
· teach child to beat drum with shaker saying 'bang bang'.
· roll drum out of reach and let child crawl after it, saying 'fetch it'.
· get child to say 'bang bang' as (s)he beats drum.

'In and Out' Toy with Blocks

· let child explore blocks and container. Put blocks into container and shake it, then teach child to take them out, one at a time, saying 'out' and 'give me'.

· teach child to take out blocks by turning container upside down.

· teach child to hold a block in each hand and bang them together.

· let child put blocks in and out of container saying 'in'.

· cover blocks with container saying 'where are they, they are under the cover'. Let the child find them. Then hide them under two and then three covers (eg pieces of cloth).

· turn the container upside down and teach the child to put blocks on top of the container.

· teach child to stack blocks, first stack two then gradually increase the number. Knock them down saying, 'up up' then 'down'. Make a game of it.

· line up blocks horizontally, first two then more, teach child to push them along making train or car noises. In older children teach stop and go, fast and slow and next to. After this teach to sort by colours, first two then more, and teach high and low building. Make up games.

Posting Bottle

· Put an object in the bottle, shake it and teach the child to turn bottle upside down and to take object out saying 'can you get it?' Then teach child to put the object in and out. Later try with several objects

Stacking Bottle Tops

· Let child play with 2 bottle tops then teach to stack them saying 'I'm going to put one on top of the other'. Later increase the number of tops. Older children can sort tops by colour and learn high and low.


· Sit child on lap. Get child to turn pages, pat pictures and vocalise. Later let child point to the picture you name. Talk about pictures, obtain pictures of similar familiar objects, people and animals. Let older children name pictures and talk about them.


· Teach the word 'baby'. Let the child love and cuddle the doll. Sing songs whilst rocking child.

· Teach child to identify his/her own body parts and those of the doll when you name them. Later (s)he will name them.

· Put the doll in a box as a bed and give sheets, teach the words 'bed and sleep', and describe the games you play.

Illustrations of the toys can be sent by post on request.

If you have any comments or queries please contact

Ann Ashworth Hill, Reader in Community Nutrition or Claire Schofield, Lecturer in Human Nutrition in the Public Health Nutrition Unit at the London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

E-mail addresses

Last updated: 7 October, 1998.