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Nutritional rehabilitation of MAM infants under 6 months admitted with an illness

This question was posted the Management of small and nutritionally at risk infants under six months and their mothers (MAMI) forum area and has 1 replies.

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Technical expert

2 Aug 2016, 15:54

The 2013 updated WHO guidelines recommends that infants under 6 months with severe acute malnutrition but no oedema, expressed breast milk should be given, and, where this is not possible, commercial (generic) infant formula or F-75 or diluted F-100 may be given, either alone or as the supplementary feed together with breast milk.

In the hospital I work in, we see a lot more infants under 6 months with moderate acute malnutrition (MAM) admitted with an illness. Most will have sub-optimal feeding and a history of poor weight gain. This means that for the first few days these infants need to supplement expressed breast milk with additional feeds. Guidelines do not mention management of MAM in hospital admission. Which supplementary feed would be optimal for feeding admitted MAM infants under 6 months?

Marie McGrath


Frequent user

2 Aug 2016, 21:56

Dear Martha,
I think it would be fine to apply the SAM guidance regarding supplementary feeds to MAM cases. The division between SAM and MAM is arbitrary - more important is whether the infant is sick or not, rather than rigidly classifying as SAM or MAM. The focus for both SAM and MAM management should be re-establishing exclusive breastfeeding as soon as possible with the necessary supports (skilled breastfeeding support with supplementary feeds in the initial stage of stabilisation if indicated).

There are a number of resources you might find helpful:
1) The recently developed C-MAMI tool, that focuses on assessment and management of acutely malnourished and nutritionally vulnerable infants under six months in community settings.
2) Module 2 on infant feeding that includes an additional part on managing severely malnourished infants under 6 months (see Chapter 8 of the Additional Part, p79).

Best regards

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