Provide sensory stimulation and

emotional support
Encourage

a cheerful, stimulating environment Structured play therapy for atleast 1530 minutes per day Physical activity as soon as the child is well enough and tender loving care

Prepare for follow-up after recovery

Recovered when wt for ht is 90% of the NCHS median Has no oedema

Criteria for discharge

Ideally 6-8 wks required for complete recovery Severely malnourished child are ready for discharge when chid is Is alert and active, eating atleast 120-130 kcal/ kg/day with a constant wt gain on exclusive oral feeding Is receiving adequate micronutrients Free from infections Completed immunisation for age Caretaker sensitised to home care

Criteria for discharge before recovery is possible

Domiciliary care only considered if child is Is aged > 12 months Has a good appetite with satisfactory weight gain Has completed antibiotic treatment Has taken 2- weeks of potassium/Mg/mineral/vitamin supplement

For child being rehabilitated at home Atleast 150 kcal/ kg/ day and adequate protein(4g/kg/day) Require feeding the child atleast 5 times a day with foods containing apprxmtly 100kcal and 2-3g protein per 100g food Vit, fe, mineral/electrolyte supplement can be continued High energy snacks should be given between meals

Primary failure to respond indicated by

to regain appetite by day 4 Failure to start losing edema by day 4 Presence of edema on day 10 Failure to gain at least 5g/kg/day by day 10
Failure

Secondary failure to respond indicated by

Failure to gain atleast 5g/ kg/ day for 3 consecutive days during the rehabilitation phase

Community based therapeutic care Suggested classification Suggested treatment

1.Severe acute malnutrition with complications like anorexia, lower respiratory tract , high fever,severe dehydration, severe anemia or lethargy 2.Severe accute malnutrition without complication where the child is clinically well, alert and has a good appetite Stabilisation centre:in-patient care,also known as phase 1 treatment , for accutely malnourished children with medical complications and no appetite using standard WHO guidelines Outpatient therapeutic programme;home based treatment and rehabilitation with a specially formulated RUTF provided on a weekly or two weekly basis, medical treatment using simplified medical protocols and regular followup Supplementary feeding programme : take home ration with moderate accute malnutrition without

3.Moderate accute malnuutrition without complications where wt for ht btwn 70-80% with no edema or