DISCHARGE FROM NUTRITIONAL PROGRAMME

Discharge children with SAM from nutritional treatment
ONLY IF:

  • Weight-for-height or length is at least ≥-2 z score and they have no oedema for at least 2 weeks, or
  • Mid-upper-arm circumference is ≥125 mm and they have no oedema for at least 2 weeks
  • The indicator used at admission should be the same one used during follow-up. If only pitting oedema was used at diagnosis, then either WFH/L or MUAC can be used for follow-up
    • Percentage weight gain should not be used as a criterion

Feeding after discharge from nutritional programme

Counsel the mother on feeding and other issues as in the table below

Feeding instructions

  • Feed child at least 5 times a day with meals that contain high energy and high protein content (100 kcal and 2-3 g protein per 100 g of food)
  • Give high energy snacks between meals (e.g., milk, banana, bread, biscuits)
  • Assist and encourage child to complete each meal
  • Give food separately to child so their intake can be checked
  • Breastfeed as often as the child wants

Additional instructions

  • How to continue any needed medications at home
  • Danger signs to bring child back for immediate care
  • When and where to go for planned follow-up: at 1 week, 2 weeks, 1 month, 3 months, and 6 months; then twice a year until when the child is 3 years old
  • Where and when to take child for growth monitoring and promotion on monthly basis up to 2 years
  • When to return for next immunisation, vitamin A, and deworming
  • How to continue stimulating the child at home with play activities

Follow-up Plan

When child is discharged, make a follow-up plan until full recovery, with the appropriate clinic (e.g., OPD, nutrition
clinic or local health worker/clinic).

  • Weigh the child weekly after discharge
  • If child fails to gain weight over 2 weeks, loses weight between 2 measurements, develops loss of appetite or
    oedema, refer child back to hospital for a full reassessment
  • Monitor child periodically after discharge from the nutritional programme to prevent relapse: at 1 week, 2
    weeks, 1 month, 3 months, and 6 months; then twice a year until when the child is 3 years old