Abstract

PIP: Severe malnutrition in children results in severe wasting and/or edema (swollen limbs). Severely malnourished children often are very ill and have complications. Health workers need to follow 10 steps first to stabilize these children and then to move them into a rehabilitation phase. During days 1-2 of the stabilization phase, health workers need to treat and/or prevent hypoglycemia (blood sugar 3 mmol/l), hypothermia (35 degrees Celsius [underarm]), and dehydration. Children with hypoglycemia should receive 50 ml of 10% glucose solution or sugar water then be fed every 2 hours round-the-clock. Health workers should either feed or start rehydration of children with hypothermia immediately, place the child on the mother's bare chest or abdomen, and cover them. They must use a modified oral rehydration salts solution and encourage feeding to rehydrate the severely malnourished child. During days 2-14 and stopping at day 14, health workers need to give broad-spectrum antibiotics to all severely malnourished children and a measles vaccine to non-immunized children and to start cautious feeding practices whereby the frequency of feeding decreases and the volume increases. Conditions that need to be addressed throughout the stabilization and rehabilitation phases include electrolyte imbalance and micronutrient deficiencies. Health workers must never treat electrolyte imbalance with a diuretic. They should not provide iron during the stabilization phase and not until a good appetite has returned and the child begins to gain weight. Health workers need to encourage sensory stimulation (tender, loving care; structured play and physical activity; stimulating environment; and mother's involvement) throughout both phases. They must focus on rebuilding tissues (catch-up growth) and preparing for follow-up during the rehabilitation phase (weeks 2-6). Once the child's appetite has returned, health workers must make a gradual transition from starter to catch-up formula and encourage continued breast feeding if the child is breast fed. They should prepare the child and parents for discharge through education on a healthy diet and eating patterns.