Model Answer
0 min readIntroduction
Severe Acute Malnutrition (SAM) is a life-threatening condition affecting millions of children globally, particularly in developing countries. It’s characterized by wasting (low weight-for-height), stunting (low height-for-age), and/or edema. The initial phase of stabilization is critical for reducing mortality and preparing the child for rehabilitation. This phase focuses on correcting electrolyte imbalances, preventing hypoglycemia, and initiating cautious feeding. The dietary plan during this phase is carefully designed to avoid refeeding syndrome, a potentially fatal metabolic disturbance. This answer will detail the dietary plan, frequency, duration, and supplementation required during this crucial stabilization period.
Initial Stabilization Phase: Dietary Plan
The initial stabilization phase typically lasts 24-48 hours, although it can extend depending on the child’s clinical condition. The primary goal is to correct immediate life-threatening complications and prepare the gut for gradual feeding.
1. Type of Feed
Initially, oral feeding is commenced cautiously with F-75 therapeutic milk. F-75 is a low-energy, high-lactose formula designed to provide essential nutrients without overwhelming the compromised gut. It contains approximately 75 kcal/kg/day, 1.5-2.5g protein/kg/day, and is lactose-based to aid in gut rehabilitation.
2. Amount and Frequency of Feed
Feeding is initiated in small, frequent amounts. The starting volume is typically 10-20 ml every 2-3 hours. This volume is gradually increased by 5-10 ml per feed, depending on the child’s tolerance. The total daily volume is divided into 6-8 feeds. Close monitoring for signs of intolerance (vomiting, diarrhea, abdominal distension) is essential. If intolerance occurs, the volume is reduced and reintroduced slowly.
3. Duration of Phase
The stabilization phase continues until the child shows clinical improvement, including stabilization of vital signs, correction of electrolyte imbalances, and tolerance of F-75 feeds without significant gastrointestinal distress. Once the child can tolerate 80-100 kcal/kg/day of F-75 without complications, they are transitioned to the rehabilitation phase.
Vitamin and Mineral Supplementation
Alongside F-75, specific vitamin and mineral supplementation is crucial during the stabilization phase:
- Vitamin A: A single oral dose of Vitamin A (100,000 IU for children 6-12 months and 200,000 IU for children >12 months) is administered to address the common Vitamin A deficiency associated with SAM.
- Zinc: Zinc supplementation (10mg daily for 14 days) is given to improve immune function and reduce the duration of diarrhea.
- Iron: Iron supplementation is generally avoided during the stabilization phase as it can exacerbate inflammation and increase the risk of infection. It is introduced later during the rehabilitation phase.
- Folate: Folate supplementation (5mg daily for 14 days) is given to address folate deficiency.
- Potassium: Potassium levels are monitored and supplemented if necessary, as hypokalemia is common in SAM.
4. Monitoring and Management of Complications
Close monitoring is paramount during this phase. This includes:
- Regular assessment of vital signs (temperature, pulse, respiration).
- Monitoring for signs of hypoglycemia (lethargy, irritability, seizures) and treating with 10% dextrose solution if needed.
- Monitoring for electrolyte imbalances (sodium, potassium, magnesium) and correcting them appropriately.
- Monitoring for signs of infection and initiating appropriate antibiotic therapy if indicated.
5. Transition to Rehabilitation Phase
Once the child is clinically stable and tolerating F-75 feeds, they are transitioned to the rehabilitation phase. This involves increasing the energy intake with F-100 therapeutic milk (approximately 100 kcal/kg/day, 10-15g protein/kg/day) and gradually introducing age-appropriate complementary foods.
Conclusion
The initial stabilization phase in managing severe acute malnutrition is a delicate process requiring careful monitoring and a tailored dietary plan. The use of F-75 therapeutic milk, coupled with appropriate vitamin and mineral supplementation, is crucial for correcting immediate life-threatening complications and preparing the child for rehabilitation. Avoiding refeeding syndrome and addressing underlying infections are key priorities. Successful stabilization lays the foundation for long-term recovery and improved nutritional status. Continued monitoring and follow-up are essential to prevent relapse.
Answer Length
This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.