Guidelines for the Inpatient Treatment of Severely Malnourished Children (UNICEF - WHO

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

(introduction...)

Every year some 12 million children die before they reach their 5th birthday. Seven out of every 10 of these deaths are due to diarrhoea, pneumonia, measles, malaria or malnutrition. The WHO/UNICEF strategy of Integrated Management of Childhood Illness (IMCI) aims at improving treatment and reducing mortality in these conditions.

The first activity of the IMCI strategy was to issue guidelines for integrated outpatient case-management, and now, preparation of guidelines for inpatient case-management is underway. The following guidelines for the routine treatment of severe malnutrition have been prepared in collaboration with WHO and form part of the nutrition component of this initiative.

These guidelines set out simple, specific instructions for the treatment of severely malnourished children. The aim is to provide practical help for those with responsibility for the medical and dietary management of such children. Without correct care, diarrhoea, poor appetite, slow recovery and high mortality are common. These problems can be overcome if certain basic principles are followed.

Severe malnutrition is defined in these guidelines as the presence of severe wasting (<70% weight-for-height or-3SD) and/or oedema.

The guidelines are in five sections:-

1. Routine treatment: The '10 steps' (section A)
2. Treatment of associated conditions (section B)
3. What to do if a child fails to respond (section C)
4. What to do when children have to be discharged early (section D)
5. Emergency treatment of shock and severe anaemia (section E)

These guidelines have been prepared by Dr Ann Ashworth (London School of Hygiene and Tropical Medicine), Dr Sultana Khanum (WHO SE Asia Office), Professor Alan Jackson (University of Southampton), and Claire Schofield (London School of Hygiene and Tropical Medicine, supported by the Canadian International Development Agency) in collaboration with WHO (Geneva), notably Dr Djamil Benbouzid, Dr Graeme Clugston and Dr Olivier Fontaine, and with Professor Michael Golden (University of Aberdeen). Thanks are due to Professor Sally Grantham-McGregor (Institute of Child Health) for the play activities, and Professor John Waterlow, Professor Joe Millward, Dr Harry Campbell, Ann Burgess and Patricia Whitesell for advice and encouragement.