Management of Malnutrition in Children Under Five Years

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Management of Severe Acute Malnutrition in Children Under Five Years

Discharge and Follow-up

The discharge criteria for severely malnourished children is applicable for both in-patient and out-patient treatment programs.

Note: Any transfer from in-patient to out-patient treatment and vice-versa should always be recorded as "transfer from" and never as "discharge" or "new admission"

• Discharge criteria for children aged 6 months to 18 years:
   
  • Weight-for-Height (W/H) and Weight-for-Length (W/L) > = 85% (WHO/NCHS table) on at least two weighing sessions

or

• No oedema for 14 days
   

• Follow-up after discharge:
   
  • Patient should be enrolled in a nutritional support program for another four-six months. For the first two months, they should attend every two weeks and than once per month if progress is satisfactory.
     
  • Patient and family should be prioritized in accessing food rations from public distribution systems.
     
  • If there is no nutritional support program near the patients' home, they should be referred to the nearest health centres or linked up with mobile clinics for continuous growth monitoring and support.

  Check the table* giving the Target weight for discharge for patients admitted with various admission weights when no height is available - used for patients admitted on MUAC alone.
  
  MUAC Resources
  
  *The table is constructed so that a person admitted with a weight-for-height of 70% (NCHS median) will be discharged when they reach 85% weight-for-height (NCHS Median). Those admitted at 65% weight-for-height will reach 79% weight-for-height at the target weight. Most patients below 65% will be treated as in-patients and will have their height measured and an individual target weight calculated.

01 November, 2009