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Sugar water on admission to a CMAM programme

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 5 replies. You can also reply via email – be sure to leave the subject unchanged.

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Kat Pittore

Save the Children India

Normal user

16 Aug 2012, 07:34

I am working on a training for a country with no history of CMAM programming and I was wondering about the importance of giving sugar water when a child is admitted to a CMAM programme in order to prevent hypoglycemia. I know the FANTA module recommends routine administration, but others I have spoken to say its not that common in practice. I know that there is no harm in administering sugar water to all children, but what would be the harm in not administering it? I know some people advocate for only giving it in cases of suspected hypoglycemia, is this more common in people's experience? What would you suggest for developing country specific organizational wide guidelines (sugar water to all children, sugar water only in cases of suspected hypoglycemia)?

Pascale Delchevalerie

Nutrition Advisor MSF Belgium

Normal user

16 Aug 2012, 09:30

Hello,

In our programs, we often propose to have sugar water in admission rooms and give it systematically (especially for new admissions) especially if you have a lot of children and if waiting time is long, as these children often have already walked some time to reach the structure and sometimes didn't eat since hours.
Sugar water (especially 5%) cannot do any harm, but if you don't have a good triage system, you may miss children with signs of hypoglycemia in the waiting room especially because early signs presents in adults are often not present in malnourished children and your staff may not differentiate a child that is simply asleep in the arms of his mother from a child who is "floppy" or loosing consciousness because of hypoglycemia.
if waiting time is not too long, you might provide only simple water because they will eat RUTF at the appetite test. For follow-up cases, if you don't do a systematic appetite test at each visit, you can explain the mothers to keep the last RUTF of the ration for the travel and the waiting time on the consultation day.

Hope this help

Mark Myatt

Consultant Epideomiologist

Frequent user

16 Aug 2012, 09:37

Not my area but here is a recollection ... When we were developing the CTC method in Ethiopia we found that carers walked many hours to access services and many children were dehydrated on arrival. Such children exhibited the typical signs / symptoms of moderate dehydration (i.e. tiredness, confusion, dizziness, irritability, elevated body temperature, and loss of appetite). This led us to refer many children for medical investigation (slowing patient flow and using scarce clinical resources) or to inpatient referral (indicated by poor appetite for RUTF). When children were given ORS or sugar water on arrival the improvement in mood and behaviour of many patients was marked. This helped with triage and patient flow. I think it good practice to provide water / ORS / sugar water in any setting where you suspect children may be dehydrated on arrival at clinic (e.g. warm climates, long distances).

BTW ... giving water also had the effect of increasing weight. A child drinking 350 ml (a typical beaker) would add 350g to their weight. This is equivalent to 0.5 WHZ in a small child.

I hope this is of some use.

Florence Turyashemererwa

Public Health Nutritionist

Normal user

16 Aug 2012, 12:12

Thank you for this very important question. I must say the sugar water is usually extremely important among cases of complicated malnutrition, and as you put it to prevent hypoglycaemia. More often when these children go to the health facility there may not be equipment to test for their sugar levels, but we know that the multiple infections they have compete with the little available glucose that they have and yet their liver cannot make sufficient glucose. So it is a good practice to routinely give this sugar water to increase their blood sugar levels. At an inpatient centre, we would expect that controlled feeding (feeds calculated to take into account the delicate nature of the child’s system at this time) will also be started soon and this should in addition help to increase the glucose supply. Thus feeding should also continue in the night. Other treatments including that for infections and management of hypothermia which usually occurs when a child has hypoglycaemia should be managed concurrently. This should usually see a child stabilise. So yes, sugar water is extremely important even if you don’t have the evidence that a child who is severely malnourished has hypoglycaemia. Hypoglycaemia can also develop after admission even if a child was tested for and found not to be hypoglycaemic if s/he is not fed immediately and frequently thereafter.

Anne Walsh

Normal user

16 Aug 2012, 17:17

In the early days of CMAM we always tried to have sugar water available recognising, as others have said, long distance to travel and waiting times. But staff often forgot to give it routinely. But what works well is to give a child a packet of RUTF on arrival, and make sure they have water to go with it. This gives them enough to prevent hypoglycaemia whilst waiting, with the added advantage of getting the a good appetite test done, and carers and children able to see and learn from each others feeding practices.
Hypoglycaemia is now extremely rare at the outpatient setting, but of course still very relevant for complicated children and inpatient care, as Florence has noted.

Martha.N

PM

Normal user

16 Aug 2012, 23:09

Hello Kat, sugar water is important and helpful if properly utilized. We run OTPs as part of CMAM. Initially we used to avail sugar for sugar-water solution but his turned out not well as the sugar was not getting to the malnourished children in proper amounts. In brief, it was misused. So right now what is done is carrying out appetite test on each child on arrival.

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