Management of Malnutrition in Children Under Five Years

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Management of Severe Acute Malnutrition in Children Under Five Years

Medical Complications

If there is a serious medical complication then the patient should be referred for in-patient treatment – these complications include the following:

• Bilateral pitting oedema Grade 3 (+++)
   
• Marasmus-Kwashiorkor (W/H<70% with oedema or MUAC<11cm with oedema)
  MUAC Resources
   
• Severe vomiting/ intractable vomiting
   
• Hypothermia: axillary’s temperature < 35°C or rectal < 35.5°C
   
• Fever > 39°C
   
• Number of breaths per minute:
   
  • 60 resps/ min for under 2 months
     
  • 50 resps/ minute from 2 to 12 months
    >40 resps/minute from 1 to 5 years
     
  • 30 resps/minute for over 5 year-olds or
     
  • Any chest in-drawing
     
• Extensive skin lesions/ infection
   
• Very weak, lethargic, unconscious
  Fitting/convulsions
   
• Severe dehydration based on history & clinical signs
   
• Any condition that requires an infusion or NG tube feeding.
   
• Very pale (severe anaemia)
   
• Jaundice
   
• Bleeding tendencies
   
• Other general signs the clinician thinks warrants transfer to the in-patent facility for assessment.

Note: Always explain to the mother/caregiver the choices of treatment option and decide with the mother/caregiver whether the child should be treated as an out-patient or in-patient despite the decision and advice of the health worker.

Source: Protocol for the management of Severe Acute Malnutrition (Ethiopia MOH)

01 November, 2009