Management of Acute Malnutrition in Infants (MAMI) Project ...

Management of Acute Malnutrition in Infants (MAMI) Project
4.4 Clinical identification of high risk infants
There is evidence that skilled breastfeeding counseling can have significant added value in improving
exclusive breastfeeding rates and outcomes in sick infants. Little consideration is given to skilled
breastfeeding support in current SAM guidelines, including for older infants and young children where it
is also important.
Based on current evidence, it is plausible that skilled breastfeeding counseling and support would also be
effective for malnourished infants; this needs to be tested in both inpatient and community-based
settings. Investigations need to also take account of staff time, skill sets and intervention costs to inform
cost-benefit analysis.
4.4 Clinical identification of high risk infants
As reflected in 4.2, clinical identification of high risk infants is lacking. Improved clinical assessment
strategies are needed to diagnose and address underlying infant or maternal disease (e.g. HIV, TB),
breastfeeding problems that are primarily infant related (e.g. oromotor dysfunction, prematurity, cleft
palate), or breastfeeding problems which are primarily mother related (e.g. poor technique, depression).
A number of different problems may co-exist in the same infant-carer dyad, or one may be dominant.
To date, tools aiding clinical identification have been mainly focused on older age groups. An ‘appetite
test’ equivalent – used in CMAM triage – is needed for infants