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1. A few symptomes and syndromes
U sual ad m issio n criteria are: M U A C < 1 1 5 m m (M U A C is no t used as an
carditmerioissnioinnchild ren o ld er than 5 9 m o nths o r taller than 1 1 0 cm ) o r W /H < – 3Z 1 o
2
p resence o f bilateral o ed em a o f the lo wer lim bs.
U sual d isch arge ( cure) criteria are: W / H > – 2 Z and absence o f bilateral o ed em a
2
(2 co nsecutive assessm ents, o ne week ap art) and absence o f acute m ed ical p ro blem s.
M ed ical m anagem ent (ho sp italisatio n o r am bulato ry care) is based o n the p resence o r
absence o f asso ciated serio us co m p licatio ns:
• C hild ren exh ibiting ano rexia, o r significant m ed ical co m p licatio ns, such as severe
sahnoaeumld iab,esheovesrpe idtaelihseydd r.atio n o r severe infectio n ( co m p licated acute m alnutritio n)
3
• C h ild ren w ith o ut sig nificant m ed ical co m p licatio ns ( unco m p licated acute
m alnutritio n) m ay und ergo treatm ent o n an am bulato ry basis, with week ly m ed ical
fo llo w-up .
Treatment
1) Nutritional treatment
Nutritio nal treatm ent is based o n the use o f therap eutic fo o d s enriched with vitam ins
and m inerals:
– T herap eutic m ilk s (fo r use exclusively in ho sp italised p atients):
• F -7 5 therap eutic m ilk , lo w in p ro tein, so d ium and calo ries ( 0 .9 g o f p ro tein and
7 5 k cal p er 1 0 0 m l) is used in the initial p hase o f treatm ent fo r p atients suffering
fro m co m p licated acute m alnutritio n. I t is used to co ver basic need s w h ile
co m p licatio ns are being treated . It is given in 8 d aily m eals.
• F -1 0 0 therap eutic m ilk , in which the co ncentratio n o f p ro tein and calo ries is higher
(2 .9 g o f p ro tein and 1 0 0 k cal p er 1 0 0 m l), rep laces F -7 5 after several d ay s,
o nce the
p atient is stabilised ( return o f ap p etite, clinical im p ro vem ent; d isap p earance o r
red uctio n o f o ed em a) . T h e o bjective is to facilitate rap id weigh t gain. I t can be
given with, o r be rep laced by , R U T F .
– R U T F (read y -to -use therap eutic fo o d ), i.e. fo o d s which are read y fo r co nsum p tio n
(fo r
exam p le, p eanut p aste enriched with m ilk so lid s, such as P lum p y ‟nut®), are used in
child ren treated in bo th ho sp ital o r am bulato ry settings. T he nutritio nal co m p o sitio n
of
R U T F is sim ilar to F -1 0 0 , but the iro n co ntent is higher. It is d esigned to p ro m o te
rap id
weight gain (ap p ro xim ately 5 0 0 k cal p er 1 0 0 g). R U T F are the o nly therap eutic
fo o d s
which can be used in am bulato ry treatm ent.
As a rule, any malnourished child presenting with medical complications should initially be hospitalised, even if
2 Some national programmes define anthropometric admission and discharge criteria with reference to NCHS
growth standards, with thresholds expressed in percentage of the median.
3
U sual ad m issio n criteria are: M U A C < 1 1 5 m m (M U A C is no t used as an
carditmerioissnioinnchild ren o ld er than 5 9 m o nths o r taller than 1 1 0 cm ) o r W /H < – 3Z 1 o
2
p resence o f bilateral o ed em a o f the lo wer lim bs.
U sual d isch arge ( cure) criteria are: W / H > – 2 Z and absence o f bilateral o ed em a
2
(2 co nsecutive assessm ents, o ne week ap art) and absence o f acute m ed ical p ro blem s.
M ed ical m anagem ent (ho sp italisatio n o r am bulato ry care) is based o n the p resence o r
absence o f asso ciated serio us co m p licatio ns:
• C hild ren exh ibiting ano rexia, o r significant m ed ical co m p licatio ns, such as severe
sahnoaeumld iab,esheovesrpe idtaelihseydd r.atio n o r severe infectio n ( co m p licated acute m alnutritio n)
3
• C h ild ren w ith o ut sig nificant m ed ical co m p licatio ns ( unco m p licated acute
m alnutritio n) m ay und ergo treatm ent o n an am bulato ry basis, with week ly m ed ical
fo llo w-up .
Treatment
1) Nutritional treatment
Nutritio nal treatm ent is based o n the use o f therap eutic fo o d s enriched with vitam ins
and m inerals:
– T herap eutic m ilk s (fo r use exclusively in ho sp italised p atients):
• F -7 5 therap eutic m ilk , lo w in p ro tein, so d ium and calo ries ( 0 .9 g o f p ro tein and
7 5 k cal p er 1 0 0 m l) is used in the initial p hase o f treatm ent fo r p atients suffering
fro m co m p licated acute m alnutritio n. I t is used to co ver basic need s w h ile
co m p licatio ns are being treated . It is given in 8 d aily m eals.
• F -1 0 0 therap eutic m ilk , in which the co ncentratio n o f p ro tein and calo ries is higher
(2 .9 g o f p ro tein and 1 0 0 k cal p er 1 0 0 m l), rep laces F -7 5 after several d ay s,
o nce the
p atient is stabilised ( return o f ap p etite, clinical im p ro vem ent; d isap p earance o r
red uctio n o f o ed em a) . T h e o bjective is to facilitate rap id weigh t gain. I t can be
given with, o r be rep laced by , R U T F .
– R U T F (read y -to -use therap eutic fo o d ), i.e. fo o d s which are read y fo r co nsum p tio n
(fo r
exam p le, p eanut p aste enriched with m ilk so lid s, such as P lum p y ‟nut®), are used in
child ren treated in bo th ho sp ital o r am bulato ry settings. T he nutritio nal co m p o sitio n
of
R U T F is sim ilar to F -1 0 0 , but the iro n co ntent is higher. It is d esigned to p ro m o te
rap id
weight gain (ap p ro xim ately 5 0 0 k cal p er 1 0 0 g). R U T F are the o nly therap eutic
fo o d s
which can be used in am bulato ry treatm ent.
As a rule, any malnourished child presenting with medical complications should initially be hospitalised, even if
2 Some national programmes define anthropometric admission and discharge criteria with reference to NCHS
growth standards, with thresholds expressed in percentage of the median.
3
