Anonymous 1310,
Below I refer to the 2013 WHO recommendations but you might need to refer to the guideline used in the country you are working in.
Should Vitamin A be given to SAM children or not?
Yes, about 5000IU/day are recommended, a daily low-dose, as opposed to a single high-dose (50 000IU/100 000IU/200 000IU). A high-dose is not required when receiving vitamine A through therapeutic food or formulations complying with WHO specifications. Two exceptions though, if SAM is associated with measles or eye signs of vitamin A deficiency, a high-dose is recommended at D1, D2 and D15.
If Vitamin A should not be given, why?
It should be given. A daily low-dose is thought to be safer and more effective in reducing RTI/diarrhoea occurrence, and kwash mortality, than a single high-dose.
If Vitamin A should be given, when? at admission or discharge or on which visit?
A daily low-dose from admission and throughout the treatment. Punctual high-doses are reserved to the above-mentioned exceptions, or if a daily low-dose is not provided.
The guideline gives details on the evidence supporting its recommendations:
http://www.who.int/nutrition/publications/guidelines/updates_management_SAM_infantandchildren/en/
Hope this helps,
Jess