D. Discharge before recovery is complete

A child may be considered to have recovered and ready for discharge when s/he reaches 90% weight-for-length. For some children, earlier discharge may be considered if effective alternative supervision is available. Domiciliary care should only be considered if the following criteria are met:

The child

· is aged >12 months
· has completed antibiotic treatment
· has good appetite and good weight gain
· has taken 2-weeks of potassium/magnesium/mineral/vitamin supplement (or continuing supplementation at home is possible)

The mother/carer

· is not employed outside the home
· is specifically trained to give appropriate feeding (types, amount, frequency)
· has the financial resources to feed the child
· lives within easy reach of the hospital for urgent readmission if child becomes ill
· can be visited weekly
· is trained to give structured play therapy
· is motivated to follow advice given

Local health workers

· are trained to support home care

· are specifically trained to examine child clinically at home, when to refer back, to weigh child, give appropriate advice

· are motivated

For children being rehabilitated at home, it is essential to give frequent meals with a high energy and protein content. Aim at achieving at least 150kcal/kg/day and adequate protein (at least 4g/kg/day). This will require feeding the child at least 5 times per day with foods that contain approximately 100kcal and 2-3g protein per 100g of food. A practical approach should be taken using simple modifications of usual home foods. Vitamin, iron and electrolyte/mineral supplements can be continued at home.

· give appropriate meals at least 5 times daily

· give high energy snacks between meals (eg milk, banana, bread, biscuits)

· assist and encourage the child to complete each meal

· give electrolyte and micronutrient supplements. Give 20ml (4 teaspoons) of the electrolyte/mineral solution daily. Since it tastes unpleasant, it will probably need to be masked in porridge, or milk (one teaspoon/200ml fluid).

· breastfeed as often as child wants