Guidelines for the Inpatient Treatment of Severely Malnourished Children

Severely malnourished children need special care. This book provides simple, practical guidelines for treating these children successfully and takes into account the limited resources of many hospitals and health units in developing countries. It is intended for doctors, nurses, dietitians and other health workers with responsibility for the medical and dietary management of severely malnourished children, and for their trainers and supervisors. The guidelines are authoritative and hospitals using them report substantial reductions in mortality. For example, mortality rates of 30-50% have fallen to 5-15%. The instructions are clear, concise and easy to follow, and the information is consistent with other WHO publications. The aim is to help improve the quality of inpatient care and so prevent unnecessary deaths. Contents......Page 4 Preface......Page 6 Acknowledgements......Page 8 Introduction......Page 10 A. General principles for routine care (the '10 Steps')......Page 11 Step 1. Treat/prevent hypoglycaemia......Page 12 Step 2. Treat/prevent hypothermia......Page 13 Step 3. Treat/prevent dehydration......Page 14 Step 4. Correct electrolyte imbalance......Page 15 Step 5. Treat/prevent infection......Page 16 Step 6. Correct micronutrient deficiencies......Page 17 Step 7. Start cautious feeding......Page 18 Step 8. Achieve catch-up growth......Page 19 Step 10. Prepare for follow-up after recovery......Page 21 1. Shock in severely malnourished children......Page 22 2. Severe anaemia in malnourished children......Page 23 2. Dermatosis......Page 24 5. Tuberculosis (TB)......Page 25 2. Low weight gain during the rehabilitation phase......Page 26 E. Discharge before recovery is complete......Page 29 Appendix 1. Weight-for-height reference table......Page 31 Appendix 2. Monitoring records......Page 33 Appendix 3. Recipes for ReSoMal & electrolyte/mineral solution......Page 34 Appendix 4. Antibiotics reference table......Page 36 Appendix 5. Recipes for starter and catch-up formulas......Page 39 Appendix 6. Volume of F-75 to give for children of different weights......Page 41 Appendix 7. Volume of F-75 for children with severe (+++) oedema......Page 42 Appendix 8. Range of volumes for free feeding with F-100......Page 43 Appendix 9. Weight record chart......Page 44 Appendix 10. Structured play activities......Page 45 Appendix 11. Discharge card......Page 48 Severely malnourished children need special care. This book provides simple, practical guidelines for treating these children successfully and takes into account the limited resources of many hospitals and health units in developing countries. It is intended for doctors, nurses, dietitians and other health workers with responsitility for the medical and dietary management of severely malnourished children, and for their trainers and supervisors