guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM Infant less than 6 months old 114
� If the SS-milk formula is changed suddenly then the infant normally takes a few days to become
used to the new taste. It is preferable to continue with the same supplementary diet throughout
the treatment.
5. Routine Medicine
These children have to be seen by a nurse every day because they are exceptionally vulnerable.
� Antibiotics: Amoxicillin (from 2kg): 30mg/kg 2 times a day (60mg/day) in association with
Gentamicin once daily. (Never use Chloramphenicol in young infants)
The surveillance is the same for infants as for older patients in Acute-phase
� Weight is measured, entered and plotted on the multi-chart each day.
� Body temperature is measured twice per day.
� The standard clinical signs are assessed and noted in multi-chart each day
� respiration
� stool
� A record is taken (on the intake part of the multi-chart) if the patient is absent, vomits or refuses
a feed
6. Care for the mothers
As the aim is to increase breast milk, the mother’s health and nutritional status are critical for the
nutritional repletion of the infant 177 .
� Check mother’s MUAC and the presence of oedema.
This infant is suckling the breast
and also getting the F100diluted
(135ml/kg/d) by the supplemental
suckling technique.
Raising or lowering the cup
determines the ease with which
the infant gets the supplement: for
very weak infants it can be at the
level of the infant’s mouth. If it is
above this level the feed can go
into the child by siphonage when
there is a danger of aspiration.
� Explain to the mother what the aim of treatment is and what is expected of her.
� Do not make the mother feel guilty for the state of her child or blame her for giving other foods.
177 The type I nutrients vary in concentration in breast milk according to the mother’s status. She does not necessarily appear
malnourished as low intakes of these nutrients do not lead to loss of body weight. If the mother’s intake is low then the first
sign of deficiency can be seen in the breast-feeding infant –there is evidence of very low levels of thiamine, vitamin B12,
pyridoxine, iodine, vitamin A, anti-oxidant nutrients, etc. in breast milk samples from many developing countries. The
exceptions are iron and copper which are physiologically at low levels in breast milk. Infants born at normal gestational age
should have stores of these nutrients to last until they are 6 months of age. Premature infants can develop iron and copper
deficiency, there should be sufficient copper in SS-milk, but if the milk is F100dilute then low-birth-weight infants may
need additional iron. The concentration of type II nutrients in breast milk is not affected by the mother’s status, but there
may be an effect upon breast milk volume (this has not been assessed adequately).