guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM Triage 34
Table 1: The amount of RUTF that should be taken to assess the appetite of severely malnourished
children
APPETITE TEST
To pass the appetite test, malnourished patients should eat at minimum an amount
above “poor”.
Body weight
Paste in sachets Paste in cups
(Proportion of whole sachet 96g) (ml or grams )
poor moderate good poor moderate good
Less than 4 kg ¼ 25
4 – 6.9 ⅓ 35
7 – 9.9 ½ 50
10 – 14.9 ¾ 75
15 - 29 1 150
Over 30 kg 1 150
Note: if cups are used then a new table should be constructed, depending on the size of the cup (often
25ml). The table should be in the number of cups the child should take for his category of weight. The
majority of children will be from 4 to 6.9kg so the minimum test to differentiate a poor appetite would then be
one level cup (of 25ml).
� The appetite test should be carried out at each visit for out-patients (particularly those who do
not gain weight steadily).
� Failure of an appetite test at any time is an indication for full evaluation and probable transfer for
in-patient assessment and treatment.
� During the second and subsequent visits the intake should be in the “good” range of table if the
patient is to recover reasonably quickly.
� If the appetite is “good” during the appetite test and the rate of weight gain at home is poor then
a home visit should be arranged because this indicates a social problem at household level or
extensive sharing of the RUTF. If the home visit is not possible, it may be necessary to bring a
child into residential care to do a simple “trial of feeding”, where the intake of the child is directly
observed by the staff, to differentiate:
• a difficulty with the home environment
• a metabolic problem with the patient;
Such a trail-of-feeding, in a structured environment (e.g. day-care, IPF), is also used to investigate
failure to respond to treatment.
3. Medical complications (IMCI)
After anthropometry and conducting the appetite test the patients are seen by the nurse to look for
complications that need to have treatment started before transfer to the in-patient facility.
If there is a serious medical complication then the patient should be referred for in-patient treatment 34
– these complications include the following 35 :
34 The same criteria are used for transfer of a child from out-patient treatment to in-patient treatment.
35 If the patients have any of these conditions they will almost certainly have failed the appetite test.