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