Guidelines for the Inpatient Treatment of Severely Malnourished Children (UNICEF - WHO - OMS, 1998, 21 p.): Appendix 2: Recipes for F-75, F-100 and F-135

Guidelines for the Inpatient Treatment of Severely Malnourished Children (UNICEF - WHO - OMS, 1998, 21 p.)

		(introduction...)
		A. General principles for routine care
		B. Treatment of associated conditions
		C. Failure to respond to treatment
		D. Discharge before recovery is complete
		E. Emergency treatment
		Appendix 1: Recipe for ReSoMal oral rehydration solution & electrolyte/mineral solution
		Appendix 2: Recipes for F-75, F-100 and F-135
		Appendix 3: F-75 feed volumes by feeding frequency and body weight
		Appendix 4: Structured play activities

Appendix 2: Recipes for F-75, F-100 and F-135

RECIPES FOR	F-75 ^a,b,c	F-100^d.	F-135^e.
	(starter)	(catch-up)	(catch-up)
Dried skimmed milk (g)	25	80	90
Sugar (g)	100	50	65
Vegetable oil (g)	30	60	85
Electrolyte/mineral solution (ml)	20	20	27
Water: make up to	1000ml	1000ml	1000ml
Contents per 100 ml	F-75	F-100	F-135
Energy kcal	75	100	135
Protein g	0.9	2.9	3.3
Lactose g	1.3	4.2	4.8
Potassium mmol	4.0	6.3	7.7
Sodium mmol	0.6	1.9	2.2
Magnesium mmol	0.43	0.73	0.8
Zinc mg	2.0	2.3	3.0
Copper mg	0.25	0.25	0.34
% energy from protein	5	12	10
% energy from fat	36	53	5.7
osmolarity (mOsmol/1)	413	419	508

^a Comparable starter formulas can be made from 35g whole dried milk, 100g sugar, 20g oil, 20ml electrolyte/mineral solution and water to 1000ml, or with 300ml fresh cow's milk, 100g sugar, 20ml oil, 20ml electrolyte mineral/solution and water to 1000ml.
^b Isotonic versions of F-75 (280mOsmol/l) are available commercially from Nutriset in which maltodextrins replace some of the sugar, and in which all the extra nutrients (K, Mg and micronutrients) are incorporated.
^c A low osmolar cereal-based F-75 (334mOsmol/l) can be made by replacing 30g sugar by 35g cereal flour. Cook for 4 minutes. This may be helpful for children with osmotic diarrhoea.
^dComparable catch-up formulas can be made from 110g whole dried milk, 50g sugar, 30g oil, 20ml electrolyte/mineral solution and water to 1000ml or 880ml fresh cow's milk, 75g sugar, 20ml oil, 20ml electrolyte/mineral solution and water to 1000ml.
^e For use in special circumstances (see section C2a, inadequate feeding)

To make up:-

· Using an electric blender mix the dried skimmed milk, sugar and oil with warm boiled water, add electrolyte/mineral solution-make up to 1000ml and blend at high speed
· If no mixer is available, mix the milk, sugar, oil and electrolyte/mineral solution to a paste, and then slowly add the warm boiled water-make up to 1000ml