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Management of SAM cases

This question was posted the Management of small and nutritionally at risk infants under six months and their mothers (MAMI) forum area and has 10 replies.

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Anonymous 40886

M40Re Analytics

Normal user

22 Jun 2022, 14:08

Hello everyone. 

How would you manage a SAM infant (7weeks) whose mother is not breastfeeding claiming she doesn't have milk. The child's current weight is 2.3kg which is below her birth weight 2.5kg. She already has old man face, loose skin and sunken fontanelle. The mother is also not cooperative and in my current location we do not have any fortified blended flour to supplement the mother although her BMI is normal?. 

Maryse Arendt

Lactation consultants Luxemburg BLL - IBFAN

Normal user

23 Jun 2022, 09:54

What does the baby get if not breastfed? It is clear that the intake is not adequate!

Anonymous 40886

M40Re Analytics

Normal user

23 Jun 2022, 10:07

Maryse Arendt 

The mother feeds diluted milk and sometimes porridge

Maryse Arendt

Lactation consultants Luxemburg BLL - IBFAN

Normal user

23 Jun 2022, 10:26

This mother needs information that this not enough and not adequate in a repectfull cultural sensitive way and listening what options she would choose for her child nutrition and health.  She woud need counselling ! If relactation is an option than the baby needs donor milk/ BMS by the same way he /she got the diluted milk until sufficient breastmilk is coming, donor milk? wet nurse? or in the last instance BMS in adequate quantity for the time the baby needs BMS and of course a one to one demonstation and exercise on how to prepare formula in the most safe way. 

Marie McGrath

Emergency Nutrition Network

Frequent user

23 Jun 2022, 11:17

Dear Anonymous_40866

This baby and mother are in urgent need of medical attention. The crtical first step of the the MAMI Care Pathway Package (integrated care model) is assessment of IMCI danger signs. See the assessment guide here. This baby is below his/her birth weight and is deydrated.  He/she may well be clincally ill. Do you have access to relevant national/local guidelines and protocols for IMCI and for severe wasting mangement?  Have you seen them in the community or at a health centre?  Is there somewhere they can be referred to and any help to enable this, like transport?  You describe the mother as uncoperative - she may be medically unwell too and/or have challenging home and social circumstances that she is contending with.   It is really critical that they get individual medical assessment and support.

Please do continue to use this forum to help support you in such a challenging situation but we must avoid attempting to mange this individual case online as this is no subsitute for the skilled assessment and support needed urgently.

Anonymous 40886

M40Re Analytics

Normal user

23 Jun 2022, 15:08

Thank you @ Maryse Arendt for the response. We counselled the mother during 2 weeks visit for postnatal clinic on importance of breastfeeding and how to reestablish breastfeeding becouse wet- nurse is not culturally acceptable for her and she can not afford commercial BMS. 

Anonymous 40886

M40Re Analytics

Normal user

23 Jun 2022, 15:51

Thank Marie McGrath for the response.

The mother- infant pair have been referred to an inpatient care in a different facility and also linked up with CHW within her reach. She was aslo accupied to the inaptient facility by the CHW to ensere that she surely get to the facility.

Marie McGrath

Emergency Nutrition Network

Frequent user

23 Jun 2022, 16:08

Dear Anonymous,

Thanks very much for the update and I am very glad to hear that the mother and infant have been referred and supported to access the critical services. This is a highly challenging case you faced and you absolutely did the right thing by asking what to do on this forum. But like I said, it is important for all to appreciate that this is not an individual medical support platform.  With this limitation in mind and with regard to this particular case, I have been contacted by two experienced paediatricans well known to the ENN who are happy to follow up with you to provide further offline support if you wish.  If you would like this, let me know (marie@ennonline.net) and I will connect you.  Warm regards, Marie

Joel Kiarie Mwaura

Nutrition and Health Specialist

Normal user

23 Jun 2022, 16:09

First, the mother and the child need urgent medical attention. While at it, the mother will require counselling to asure her of her ability to breastfeed, as well as find out what factors may have led to her low lactation. The attachment of the baby to the breast, as well as positioning during breastfeeding should also be assessed and if need be, corrected. A good family support and socio-cultural systems are also key to successful breastfeeding as they reduce any risks of psychological stress that may affect the mother.

Anonymous 40886

M40Re Analytics

Normal user

23 Jun 2022, 17:29

Thank you very @Marie McGrath

Anonymous 40886

M40Re Analytics

Normal user

23 Jun 2022, 17:36

@ Joel kiarie mwaura. 

Thank you very much for the response

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