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P. 48
ere acute malnutrition
F urtherm o re, it is im p o rtant to give d rink ing water, in ad d itio n to m eals, esp ecially if
the am bient tem p erature is high o r the child has a fever.
B reastfeed ing sho uld co ntinue in child ren o f the ap p ro p riate age.
2) Routine medical treatment
I n th e absence o f sp ecific m ed ical co m p licatio ns, th e fo llo wing ro utine treatm ents
sh o uld be im p lem ented in bo th am bulato ry and ho sp ital settings:
– Infections
• M easles vaccinatio n o n ad m issio n.
• B ro ad sp ectrum antibio tic th erap y starting o n D ay 1 ( amoxicillin P O : 7 0 to
1 0 0 m g/ k g/ d ay in 2 d ivid ed d o ses fo r45 d ay s) .
• I n end em ic m alaria areas: rap id test o n D 1 , w ith treatm ent in acco rd ance with
results. If testing is no t available, give m alaria treatm ent (p age 1 3 1 ).
• T reatm ent fo r intestinal wo rm s o n D 8 :
albendazole P O
C hild ren > 6 m o nths: 4 0 0 m g as a single d o se (2 0 0 m g in child ren > 6 m o nths but
< 1 0 k g)
– Micronutrient deficiencies
T herap eutic fo o d s co rrect m o st o f these d eficiencies.
3) Management of common complications
– Diarrhoea and dehydration
D iarrh o ea is co m m o n in m alno urish ed ch ild ren. T h erap eutic fo o d s facilitate th e
reco very o f gastro intestinal m uco sa and resto re th e p ro d uctio n o f gastric acid ,
d igestive enz y m es and bile. A m o xicillin, ad m inistered as p art o f ro utine treatm ent, is
effective in red ucing bacterial lo ad . D iarrh o ea generally reso lves w ith o ut any
ad d itio nal treatm ent.
W atery d iarrh o ea is so m etim es related to ano th er p ath o lo gy ( o titis, p neum o nia,
m alaria, etc.), which sho uld be co nsid ered .
I f an aetio lo gical treatm ent is necessary , see p age 8 3 .
I f a child h as a significant d iarrh o ea ( very frequent o r abund ant sto o ls) but is no t
d ehy d rated , ad m inister sp ecific o ral rehy d ratio n so lutio n (R eS o M al, see belo w), after
each
watery sto o l, to avo id d ehy d ratio n, acco rd ing to the W H O treatm ent P lan A (p age
3 1 6 ).
H o wever, if the child has no p ro fuse d iarrho ea, give p lain water (no t R eS o M al) after
each lo o se sto o l.
D ehy d ratio n is m o re d ifficult to assess in m alno urished than healthy child ren (e.g.,
d elay in return o f sk in p inch and sunk en ey es are p resent even witho ut d ehy d ratio n
in child ren with m arasm us.).
If specific signs of infection are present, the choice of treatment should be directed by the suspected focus.
Complete curative treatment with vitamin A is reserved for patients presenting with clinically detectable ocular
4
5
lesions (see Vitamin A deficiency, page 121).
42
F urtherm o re, it is im p o rtant to give d rink ing water, in ad d itio n to m eals, esp ecially if
the am bient tem p erature is high o r the child has a fever.
B reastfeed ing sho uld co ntinue in child ren o f the ap p ro p riate age.
2) Routine medical treatment
I n th e absence o f sp ecific m ed ical co m p licatio ns, th e fo llo wing ro utine treatm ents
sh o uld be im p lem ented in bo th am bulato ry and ho sp ital settings:
– Infections
• M easles vaccinatio n o n ad m issio n.
• B ro ad sp ectrum antibio tic th erap y starting o n D ay 1 ( amoxicillin P O : 7 0 to
1 0 0 m g/ k g/ d ay in 2 d ivid ed d o ses fo r45 d ay s) .
• I n end em ic m alaria areas: rap id test o n D 1 , w ith treatm ent in acco rd ance with
results. If testing is no t available, give m alaria treatm ent (p age 1 3 1 ).
• T reatm ent fo r intestinal wo rm s o n D 8 :
albendazole P O
C hild ren > 6 m o nths: 4 0 0 m g as a single d o se (2 0 0 m g in child ren > 6 m o nths but
< 1 0 k g)
– Micronutrient deficiencies
T herap eutic fo o d s co rrect m o st o f these d eficiencies.
3) Management of common complications
– Diarrhoea and dehydration
D iarrh o ea is co m m o n in m alno urish ed ch ild ren. T h erap eutic fo o d s facilitate th e
reco very o f gastro intestinal m uco sa and resto re th e p ro d uctio n o f gastric acid ,
d igestive enz y m es and bile. A m o xicillin, ad m inistered as p art o f ro utine treatm ent, is
effective in red ucing bacterial lo ad . D iarrh o ea generally reso lves w ith o ut any
ad d itio nal treatm ent.
W atery d iarrh o ea is so m etim es related to ano th er p ath o lo gy ( o titis, p neum o nia,
m alaria, etc.), which sho uld be co nsid ered .
I f an aetio lo gical treatm ent is necessary , see p age 8 3 .
I f a child h as a significant d iarrh o ea ( very frequent o r abund ant sto o ls) but is no t
d ehy d rated , ad m inister sp ecific o ral rehy d ratio n so lutio n (R eS o M al, see belo w), after
each
watery sto o l, to avo id d ehy d ratio n, acco rd ing to the W H O treatm ent P lan A (p age
3 1 6 ).
H o wever, if the child has no p ro fuse d iarrho ea, give p lain water (no t R eS o M al) after
each lo o se sto o l.
D ehy d ratio n is m o re d ifficult to assess in m alno urished than healthy child ren (e.g.,
d elay in return o f sk in p inch and sunk en ey es are p resent even witho ut d ehy d ratio n
in child ren with m arasm us.).
If specific signs of infection are present, the choice of treatment should be directed by the suspected focus.
Complete curative treatment with vitamin A is reserved for patients presenting with clinically detectable ocular
4
5
lesions (see Vitamin A deficiency, page 121).
42
