Management of complicated severe acute malnutrition in children in resource-limited countries
- Indi Trehan, MD, MPH, DTM&H
Indi Trehan, MD, MPH, DTM&H
- Medical Director, Lao Friends Hospital for Children, Luang Prabang, Laos
- Associate Professor of Pediatrics, Washington University in St. Louis
- Mark J Manary, MD
Mark J Manary, MD
- Helene B Roberson Professor of Pediatrics,
- Washington University in St. Louis
- Section Editors
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
- B UK Li, MD
B UK Li, MD
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- Medical College of Wisconsin
Severe acute malnutrition (SAM) is a pervasive problem throughout resource-limited ("developing") countries. Severely malnourished children are often identified when brought to medical attention for an acute issue such as diarrhea or fever, but should also be sought through community-wide screenings of vulnerable children in high-risk settings. In some cases SAM is precipitated by political disruptions like war or natural disasters like drought, which interfere with the food supply. However, more often SAM is simply a disease of pervasive poverty and poor hygienic conditions, compounded by seasonal shortages of food and spikes in illnesses such as malaria or infectious diarrhea.
This topic review will discuss treatment of children with SAM with complications such as intercurrent infections. Affected children are treated as inpatients in hospitals or feeding centers, using protocols promoted by the World Health Organization (WHO). In the past, this approach was used for most children with SAM. However, experience over the last 15 to 20 years has demonstrated that children with uncomplicated SAM, constituting the vast majority of malnourished children, can and should be treated at home with support from outpatient feeding programs. This community-based management of acute malnutrition (CMAM) approach appears to produce equal or better recovery and case fatality rates, to widen population coverage, and has been successfully implemented worldwide by governments and relief organizations. As a result, CMAM has become the international standard of care for uncomplicated cases of severe malnutrition [1-3]. (See "Management of uncomplicated severe acute malnutrition in children in resource-limited countries".)
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- Children 6 through 59 months old
- Other age groups
- OVERVIEW OF INPATIENT MANAGEMENT
- INITIAL STABILIZATION PHASE
- - Empiric antibiotics
- - HIV infection and antiretrovirals
- - Antimalarials
- - Antihelminthics
- - Antipyretics
- - Immunizations
- - ReSoMal
- - Rehydration methods
- - Target for volume replacement
- Initial nutrition
- - RUTF appetite test
- - F-75 and F-100 formula diets
- REHABILITATION PHASE
- Feeding advancement
- - Children six months and older
- - Infants zero to six months
- Vitamin and mineral supplementation
- FAILURE TO RESPOND
- Review of rehabilitation failure
- COGNITIVE AND FAMILY REHABILITATION
- Environmental stimulation
- Parent education
- DISCHARGE PHASE
- Transfer to outpatient care
- Discharge from treatment
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS