If child has signs of vitamin A deficiency like corneal ulceration

  • Give vitamin A on day 1, repeat on days 2 and 14
    Child <6 months: 50,000 IU Child 6-12 months: 100,000 IU Child >12 months: 200,000 IU

If a first dose was given in the referring centre, treat on days 1 and 14 only

If eyes show corneal clouding or ulceration, give care below to prevent corneal rupture and lens extrusion

  • Instil chloramphenicol or tetracycline eye drops 4 times a day, for 3-5 days
  • Instil atropine eye drops, 1 drop 3 times a day for 3-5 days
  • Cover with saline soaked pads
  • Bandage the eyes


Usually due to zinc deficiency. The child’s skin quickly improves with zinc supplementation. In addition:


  • Bathe or soak affected areas for 10 minutes per day in 0.01% potassium permanganate solution
  • Apply barrier cream (zinc and castor oil ointment or petroleum jelly) to the raw areas, and gentian violet or
    nystatin cream to skin sores
  • Avoid using nappies so that the perinuem can stay dry



Severe anaemia

  • Give blood transfusion in the first 24 hours ONLY IF:
    • Hb is <4 g/dL
    • Hb is 4-6 g/dl, and the child has respiratory distress
  • Use smaller volumes and slower transfusion than for a well-nourished child. Give:
    • Whole blood, 10 ml/kg over 3 hours
    • Furosemide, 1 mg/kg at the start of the transfusion

If child has signs of heart failure

  • Give 10 mL/kg of packed cells, as whole blood may worsen heart failure
  • Children with SAM and oedema may have redistribution of fluid leading to apparent low Hb, which does not
    require transfusion


  • Monitor pulse and breathing rates, listen to lung fields, examine adbomen for liver size, check jugular venous
    pressure every 15 minutes during transfusion

    • If either breathing rate increases by 5 breaths/minute or heart rate increases by 25 beats/minute, transfuse more slowly
    • If there are basal lung crepitations or an enlarging liver, stop transfusion and give IV furosemide IV at 1 mg/kg



If Giardiasis suspected or confirmed by stool microscopy

  • Give metronidazole 7.5 mg/kg every 8 hours for 7 days

If due to lactose intolerance (very rare)
Diagnosed if profuse watery diarrhoea only occurs after milk-based feeds are begun and stops when they are
withdrawn or reduced

  • Replace feeds with yoghurt or a lactose free infant formula
  • Reintroduce milk feeds gradually in the rehabilitation phase

Osmotic diarrhoea
Suspect if diarrhoea worsens substantially with hyperosmolar F-75 and ceases when sugar and osmolality
are reduced

  • Use a cereal-based starter F-75, or if necessary, a commercially available isotonic starter
  • Introduce catch-up F-100 or RUTF gradually