Describe the In-patient feeding protocols

- Patients with complicated SAM should be admitted to an inpatient facility for the
stabilization phase. This is achieved with F75 therapeutic milk and specific medical
treatment. Meals are given six to eight times per 24 hours (throughout the day and night).
The patient should not receive any other food during this period.
- When appetite returns and oedema is reduced, the patient is ready for the transition phase
of inpatient care. During the transition phase the patient is supposed to receive an
increased amount of energy, but still needs careful monitoring. If it is possible to admit
the patient for outpatient care, RUTF should be given. If the patient does not take enough
RUTF or has difficulties swallowing, a replacement feed (F100, a specialized therapeutic
milk to promote weight gain) is given. As soon as the child starts gaining weight without
developing complications he or she is upgraded to the rehabilitation phase, which ideally
should be implemented in outpatient care. When this is not possible, the patient should
stay in inpatient for the remainder of treatment with F100.
- Patients in the rehabilitation phase have either passed through stabilization and transition
phases or have a good appetite and no complications from the start and have been
admitted directly into the rehabilitation phase as outpatients. RUTF, a paste or crushable
biscuit that has the same composition of F100, is the therapeutic food used in outpatient
care. Specific amounts are given for the week, according to the child’s weight. The
objective is to maintain weight gain. It is important to train mothers or caretakers during
the rehabilitation period on how to feed their child with available local foods.
- Throughout treatment, it is important to promote emotional and physical stimulation of
the child, to prevent developmental delays and mental disorders. Special programmes for
this should be organized in all centres.
- During outpatient care, the patient visits outpatient facilities every week or every two
weeks for follow-up treatment and receives routine drugs and RUTF. During these visits,
health and nutritional education, with an emphasis on appropriate infant and young child
feeding practices, should be given. If the patient is not recovering at home, or if
complications occur, the patient is assessed by a clinician and referred to inpatient care if
necessary. During treatment, the patient is monitored through a patient’s card where
weight, MUAC, clinical assessments and treatment received are noted.
- Infants below six months of age (or below 3 kg of weight) are treated with a different
protocol aimed at reinstating breastfeeding, when this is appropriate for the mother or
another female caregiver. This is achieved by a method called supplementary suckling
where the infant is fed diluted F100 through a tube attached to the mother's nipple
thereby stimulating milk production at the same time as being fed.
- HIV-infected malnourished patients can recover their nutritional status with these
protocols although minor modifications may need to be made to the antibiotics given. To
prevent toxicity, antiretroviral drugs are started only when nutritional status improves and
any metabolic disturbances have been corrected.
- Patients are discharged from outpatient care when they meet target weight-for-height or
MUAC, and have good weight gain with no signs of oedema for two weeks. Patients
discharged from therapeutic care are then followed up at an SFP for a period of four
months.

---

Titany answered the question on November 11, 2021 at 13:35