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MODULE 4 FEEDING Training Course on Inpatient Management of Severe Acute Malnutrition (Adapted from the 2002 WHO Training course on inpatient management of severe acute malnutrition) Children 6–59 Months with SAM and Medical Complications March 2012 This modified version of the 2002 World Health Organisation’s Training Course on Inpatient Management of Severe Acute Malnutrition (SAM) is the practical application of the 2010 MOH/GHS Interim National Guidelines for Community-Based Management of Severe Acute Malnutrition in Ghana. The training course was modified by the MOH/GHS SAM Support Unit in collaboration with the MOH/GHS Regional SAM Support Teams. USAID/Ghana, FANTA-2 Bridge project, UNICEF/Ghana and WHO/Ghana provided technical and financial support to review and modify the training course. This revised training course is made possible by the generous support of the American people through the support of USAID/Ghana and the Office of Health, Infectious Diseases, and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), under terms of Cooperative Agreement No. AID-OAA-A-11-00014, through the FANTA-2 Bridge, managed by FHI 360. Illustrations for modules: Susan Kress Ghana Inpatient Care Training Materials | Module 4. Feeding | March 2012 Contents Acronyms and Abbreviations ..................................................................................................... i Introduction ................................................................................................................................ 1 Learning Objectives ................................................................................................................... 2 1. Prepare F-75 and F-100 Feeds and Learn about RUTF ....................................................... 3 1.1. Prepare F-75 and F-100 ......................................................................................... 3 1.2. Ready-to Use-Therapeutic Food ............................................................................ 8 Exercise A ...................................................................................................................... 9 2. Feed the Child with F-75 during Stabilisation ................................................................... 10 2.1. Determine the Frequency of Feeds ...................................................................... 10 2.2. Determine the Amount of F-75 Needed per Feed ............................................... 10 2.3. Record the Child's 24-Hour Feeding Plan ........................................................... 13 2.4. Feed the Child F-75 Orally or by Nasogastric Tube, if Necessary...................... 13 2.5. Record Intake and Output on a 24-Hour Food Intake Chart ............................... 15 2.6. Adjust the Child’s Feeding Plan for the Next Day .............................................. 19 Exercise B .................................................................................................................... 20 3. Feed the Child during Transition ....................................................................................... 29 3.1. Recognise Readiness for Transition .................................................................... 29 3.2. Transition Using RUTF (Introduce RUTF Slowly and Gradually) ..................... 30 3.3. If RUTF Cannot be Given, Transition Using F-100 Slowly and Gradually ....... 31 3.4. Monitor the Child Carefully during Transition ................................................... 32 3.5. Record Intake/Output and Plan the Child's Feeds for the Next 24 Hours ........... 32 3.6. Criteria to Move Back From Transition to Stabilisation Phase .......................... 32 Exercise C .................................................................................................................... 34 4. Feeding on RUTF or Freely with F-100 during Rehabilitation ......................................... 38 4.1. Feeding during Rehabilitation on RUTF ............................................................. 38 4.2. Feed Freely with F-100 during Rehabilitation .................................................... 38 4.3. Encourage the Child to Eat Freely at Each Feed ................................................. 38 4.4. Record Intake/Output; Determine if Intake of F-100 is Acceptable ................... 39 4.5. Adjust the Feeding Plan for F-100 as Necessary ................................................. 40 Exercise D .................................................................................................................... 41 5. Plan Feeding for Inpatient Care ......................................................................................... 47 5.1. Determine a Schedule for Feeding and Related Activities in Inpatient Care ...................................................................................................................... 47 Exercise E .................................................................................................................... 50 5.2. Prepare a Daily Inpatient Care Feed Chart .......................................................... 52 Exercise F..................................................................................................................... 54 TRAINING COURSE ON INPATIENT MANAGEMENT OF SEVERE ACUTE MALNUTRITION Children 6–59 Months with SAM and Medical Complications Ghana Inpatient Care Training Materials | Module 4. Feeding | March 2012 5.3. Plan Staff Assignments Related to Feeding Children ......................................... 56 5.4. Prepare Staff to Do Assigned Feeding Tasks ...................................................... 56 Exercise G .................................................................................................................... 58 6. Management of SAM in Infants under 6 Months .............................................................. 59 6.1. Breastfed Infants under 6 Months of Age with a (Potential) Lactating Mother ................................................................................................................. 59 6.2. Infants under 6 Months without the Prospect of Breastfeeding .......................... 67 6.3. Infant and Young Child Feeding Support ........................................................... 73 Summary of the Management of SAM in Infants under 6 Months of Age ................. 74 Annex A. F-75 and F-100 Reference Tables .......................................................................... 75 Annex B. Danger Signs for the Management of SAM in Children under 5 in Inpatient Care ......................................................................................................... 78 Annex C. RUTF Reference Table and Key Messages ........................................................... 79 Annex D. F-100-Diluted (and F-75) Reference Tables for Infants under 6 Months of Age ......................................................................................................................... 80 Annex E. 24-Hour Food Intake Chart .................................................................................... 82 Annex F. Daily Inpatient Care Feed Chart ............................................................................ 83 Answers to Short Answer Exercises ........................................................................................ 84 TRAINING COURSE ON INPATIENT MANAGEMENT OF SEVERE ACUTE MALNUTRITION Children 6–59 Months with SAM and Medical Complications
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