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Minimum flexible discharge criteria for inpatient SAM children

This question was posted the Management of wasting/acute malnutrition forum area and has 1 replies.

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Asfia Azim

Nutrition Officer, UNICEF

Normal user

4 Aug 2020, 07:43

In Bangladesh, the majority of parents of children with SAM do not want to stay at hospital to finish the full treatment of SAM as it requires a longer period to stay at hospital. A large number of parents go back home within a 5-7 day period.

Is there any standard/practical criteria for minimum stay? For example, moderate weight gain (gm)/kg/day or 15% wt. gain or minimum number of days etc.?

Please share if anyone has any practical experience. Thank you.

Paul

Technical expert

11 Sep 2020, 09:16

Hi Asfia,

For treatment in inpatient care until cure the discharge is based on anthropometric as well as clinical criteria. For children aged 6-59 months there is no ideal discharge criterion for discharging children home (discontinuing treatment) before cure is reached. For infants aged less than 6 months there is the possibility to discharge the infant based on weight gain for 3 consecutive days (see national guidelines or WHO update 2013), however acheiving this within a 5 day period is unlikely. 

An alternative for children aged 6 months or older is to acquire some RUTF then to discharge the child according to standard phase 1 discharge criteria. Before discharge the child should be transitioned from F75 / F100 to RUTF and observed eating adequate RUTF for 24 hrs minimum without any ill effects. Typically this takes 4-7 days depending on the clinical condition of the child, although it can take longer depending on hte efficiency of the transition in diet. The child should then attend for weekly follow up until cure according to standard criteria

I hope this helps,

Paul

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