guidelines for the integrated management of severe acute malnutrition

More documents

Recommendations

Info

ACF-In Guidelines for the integrated management of SAM Infant less than 6 months old 110 • if they are losing weight or have crossed weight-for-age centile lines because their weight is static then they should be admitted to the programme. Where there is no growth monitoring programme or there are no “historical” weight measurements and the mother reports that she does not have sufficient breast milk or that the infant “does not like my breast milk”: • The weight-for-age of the infant should be checked • The infant is checked clinically • The mother’s breasts examined • The mothers breast-feeding performance is observed If the infant is clinically well and appears to be breast feeding satisfactorily, the mother should be counselled and given a return appointment in one or two weeks to monitor the weight change of the infant (an accurate infant scale is needed – not a survey scale with 100g divisions). • Where the infant has a clinical illness, • the mother’s breast feeding performance is not satisfactory, • the infant appears clinically malnourished, � The infant and mother should be admitted to the programme. To resume: AGE ADMISSION CRITERIA Infant less than 6 months or less than 3 kg being breast-fed 3. Management � The infant is too weak or feeble to suckle effectively (irrespective of his/her weight-for-length, weight-for-age or other anthropometry). or � The infant is not gaining weight at home (by serial measurement of weight during growth monitoring, i.e. change in weight-for-age) or � W/L (Weight-for-Length) less than
ACF-In Guidelines for the integrated management of SAM Infant less than 6 months old 111 This is achieved by stimulating breast-feeding at the same time as supplementing the child during breast feeding until breast milk is sufficient to allow the child to grow properly. Breast milk output is stimulated by the Supplemental Suckling (SS) technique 171 ; it is important to put the child to the breast as often as possible. � Breast-feed every 3 hours for at least 20 minutes, more often if the child cries or seems to want more. � If the child is too weak to suckle, but the mother has milk, the mother should be shown how to express her milk by hand or by pump 172 . The expressed milk can be given by cup or by NG-tube to the baby � Thirty to sixty minutes after offering a normal breast-feed give maintenance amounts of either F100diluted or generic infant formula using the supplementary suckling technique: � The diet should provide 100kcal/kg/day. For most infant formulae give 140ml/kg/d, for F00dilute, give135ml/kg/day - divided into 8 meals. There are not separate phases in the treatment of infants with the SS technique. There is no need to start with F75 and then switch to F100diluted unless the infant has oedema. A specific multi-chart is used for these infants. Preparation of the SS-milk 173 The SS-milk can be infant formula or made by diluting F100 to make F100diluted. Infant formula is diluted according to the supplier’s instructions. - For F100diluted put one small packet of F100 into 670ml of water instead of 500ml 174 . - To make small quantities of F100 diluted, � Use 100ml of F100 already prepared and add 35ml of water, then you will get 135ml of F100diluted. Discard any excess waste. Don’t make smaller quantities. � If you need more than 135ml, use 200ml of F100 and add 70ml of water, to make 270ml of F100 diluted and discard any excess waste. - If there is a choice, use a formula designed for premature infants (Yet the purchase of infant formula should comply with The Code and IFE guidelines). Note: � Unmodified powdered whole milk should never be used (e.g. Nido®) � F100 undiluted is never used for small infants (less than 3kg) view that attempts at exclusive breast feeding will not work when the infant has reached this stage. On the other hand treating the infant with F75 and then F100 rapidly leads to weaning and the mother sees that the “formula” is the only way to allow her child to recover. Urging the mother to breast feed after this is unsuccessful (as given in manuals for treatment of SAM). These are both losing options. The SS technique is time consuming and requires skill, but is the only technique that works in practice; it is lifesaving. 171 This is the SAME as the techniques described in textbooks for re-lactation [118]. 172 See Module 2 http://www.ennonline.net/resources/4, for more information on expressing breast-milk 173 Full strength F100 should NEVER be used for small infants of children less than 3kg. The renal solute load is too high for this category of child and could provoke hypernatraemic dehydration. Older children must either be given ordinary water with the diet if they are less than 3kg or the diet should be diluted. 174 Or one large packet into 2.7 l of water instead of 2l to make F100 diluted.
Page 1 and 2:
�� ACF INTERNATIONAL GUID
Page 3 and 4:
ACF-In Guidelines for the integrate
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60: ACF-In Guidelines for the integrate
Page 109: ACF-In Guidelines for the integrate
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Cover photography: © ACF, Anne-Dom
show all

guidelines for the integrated management of severe acute malnutrition

Create successful ePaper yourself

Delete template?

Save as template?