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How to manage a Marasmic Child

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 8 replies. You can also reply via email – be sure to leave the subject unchanged.

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Zakayo

Nutrition Officer

Normal user

26 Mar 2013, 13:44

If you were to manage a child aged months weighing 3kg with a MUAC 6.8, has never breastfed. Complementary food started at 2 wks.
Currently Started F100 but the child has good appetite 3 hourly feeds need your advise want really to save this life. No other complications yet but was treated pneumonia and malaria.

Anne Walsh

Normal user

27 Mar 2013, 08:23

Hello, can you give a little more information - how many months is the child and where are you? Who is caring for the child? If there is no chance of the mother relactating, are there any extended family or community options for breast milk? Is there access to infant formula? Decisions on treatment for an infant like this need to based on what is realistic in the context you are in.

Kwamboka

Nutrition Coordinator

Normal user

27 Mar 2013, 19:38

You have not stated the age of this child, this could have helped to determine the best feed for intervention. From the stated weight of 3kg i want to imagine the child is below six months. This child needs needs urgent access to a stabilisation centre for management with dilute F100. Since child has no prospects of being breastfed you need use the recommended volumes. 130ml/kg b.w. then increase amount by 1/3 then finally double the original amount. On discharge the child needs to be supported for replacement feeding and further medical investigations like PCR for HIV needs to be done to determine the serostatus so as to assertain reason for failure to thrive. MUAC is a good predictor of mortality and this child's MUAC is evident that it is in danger of death. This child needs urgent help to enable you save the child's life.

Anne Walsh

Normal user

29 Mar 2013, 09:04

If the child is 6 months old and has appetite is there nowhere that has a supply of Ready to Use Therapeutic Food? Unicef would be able to tell you where there are Outpatient Therapeutic Programmes (OTPs) running - if there are any OTPs they will certainly have RUTF.

Alexandra Rutishauser-Perera

International Medical Corps

Normal user

29 Mar 2013, 12:05

Did you try the suckling technique with the mum to restart the milk flow? is there anybody alse in the family who could breasftfeed the child?
I also agree with the suggestion to use RUTF in OTP but the child is clearly at risk of relapse ... Are there possibilities to link the mother to any social services? Can CHWs make follow-up visits with her ? Do you have any peer groups who could take care of the mother once the child will be discharged from the program?

Chantal Autotte Bouchard

AAH

Normal user

29 Mar 2013, 14:38

Hi,

Supplementary feeding and TSS will be great like Anna and Alexandra said. But you also said that she have a good appetite and 6 month. Maybe you can also try the diversification food. But the best will be to sent her where they have a center where they manage malnutrition and care practice. Wich country you are?

C

Tarig Mekkawi

CMAM / Emergency Nutrition Officer , UNICEF , Suda

Normal user

29 Mar 2013, 16:31

Hi , this child situation is very special as he is less than 4 kg weight which classifies him as special case and he is severely wasted , the child will need cautious support in away that we do not overburden his liver and hence the way I suggest is to start the F100 diluted with him and give him a chance to put on some weight .careful follow up and nursing such child is subjected easily to hypoglycemia and/or hypothermia due to severe wasting . Once he started to sustain the adequate weight gain of 20 gram/kg/ day for few days then we shift him to F100 . The RUTF as per my experience in such wasted children might help in gaining weight but again this child better to be in inpatient care for a while to avoid hypothermia and hypoglycemia.
The child should be discharged on complementary food like modified animal milk or fortified blended food . This is a kind of cases that home visits is necessary after discharge to monitor progress. While he is in the feeding center if he is subjected to recurrent infections like malaria or pneumonia this might be due to malnutrition or secondary immunodeficiency.
.

Tarig Mekkawi

CMAM / Emergency Nutrition Officer , UNICEF , Suda

Normal user

29 Mar 2013, 16:40

At any point the child develop medical complications then he must be on F75 , keep reminded tthat in such children the two essentials goals for managging the case are prevention of likely complications and then restoration of some physiological capacity to allow him for catch up. We have seen in Sudan many similar cases and the good thing is that most of them shown remarkable gain of weight with this kind of management .we should be carefull also on when to refer such child to TOP and also not to keep him too much in inpatient care.

Tamsin Walters

en-net moderator

Forum moderator

7 Apr 2013, 19:04

From Zakayo Kimuge:

The child is doing very well. She has so far gained 600gms as per Wednesday. I always see her when I go for dressing. No more crying and she sleeps well. We agreed with my colleague that we monitor her until she is fully recovered. Then we discharge her with either CSB or first food and RUTF.

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