After assessing and classifying a child with malnutrition or anaemia, it is critically important that you treat the child correctly. Identifying and managing the treatment of a malnourished child will help you to promote a healthy life and may even help to save a child‘s life.
Treatment of severely complicated malnutrition in an infant < 6 months old
Children with severely complicated malnutrition must always be referred urgently to hospital. Before the child leaves the hospital, you should treat the child to prevent low blood sugar. You should also give the child the first dose of vitamin A if you do not identify any oedema and the child has not received vitamin A in the past six months (see session6).Give the first dose of Amoxicillin. Advise the mother on the need of referral. Refer URGENTLY to a health facility (where there is a stabilisation centre).
Treatment of severely complicated malnutrition in an infant > 6 months old
Children with severely complicated malnutrition must always be referred urgently to hospital. Before the child leaves for the hospital, you should treat the child to prevent low blood sugar. You should also give the child the first dose of vitamin A if you do not identify any oedema and the child has not received vitamin A in the past six months (see session6). Give first of Amoxicillin. Advise the mother on the need of a referral. Refer URGENTLY to the health facility (where there is a stabilisation centre).
Pre-referral oral Amoxicillin dose for severely complicated malnutrition
| Weight in Kg |
Dose twice per day |
250 Capsule /Tablet |
| <5 |
125mg |
½ |
| 5-10 |
250mg |
1 |
| 10-20 |
500mg |
2 |
| 15-35 |
750mg |
3 |
| >35 |
1000mg |
4 |
Prevent Low Blood Sugar for a child on the way to the health centre or hospital for severely complicated malnutrition.
If the child can breastfeed:
- Ask the mother to breastfeed the child.
If the child is not able to breastfeed but can swallow:
- Give expressed breast milk.
- If neither of these is available give sugar with water: 30-50 ml of milk or sugar with water before departure.
- To make sugar water: Dissolve 4 level teaspoons of sugar (20 grammes) in a 200-ml cup of clean water.
Treatment of severe uncomplicated malnutrition in children > 6 months old
Register in OTP and do the following:
If a child has severe uncomplicated malnutrition, and there is an out-patient therapeutic programme (OTP) service in your health post, then you can manage the child according to the OTP protocol. If the service is not available in your health post, you should refer the child to a health facility where there is one.
You should give all children with a classification of severe uncomplicated malnutrition the following treatment:
- Vitamin A (unless there is the presence of oedema or they have already received vitamin A in the past six months).
- Give amoxicillin for 7 doses.
- Give single dose of 5mg folic acid for those with anemia.
- Ready-to- use therapeutic food (RUTF) such as Plumpy‘nut® or BP-100®.
- Give the child mebendazole or albendazole for age two years or above; you should also give, preferably at the second out-patient visit which should take place seven days after the first visit to your health post. You will need to advise the mother that she should return for a follow-up visit within seven days so that you can see whether the child has made progress.
- Advise the mother when to return immediately.
- Follow up in 7 days.
- The Outpatient management of uncomplicated severe malnutrition for Children (> 6 months) with severe acute malnutrition (SAM) WITHOUT medical complications and who PASS the appetite test – are treated with RUTF in the health post which has OTP according to the following table.
Children > 6 months with severe acute malnutrition (SAM) without medical complications and who PASS the appetite test. Treatment with RUTF in the health facility with OTP
| Weight of Child (kg) |
RUTF (Plumpy Nut) |
BP 100 biscuits |
| Sachet per day |
Sachet per week |
Bars per day |
Bars per week |
| 3.0 up to 3.5 |
1¼ |
9 |
2 |
14 |
| 3.5 up to 5.0 |
1 ½ |
11 |
2 ½ |
18 |
| 5.0 up to 7.0 |
2 |
14 |
4 |
28 |
| 7.0 up to 10 |
3 |
21 |
5 |
35 |
| 10 up to 15 |
4 |
28 |
7 |
49 |
| 15 up to 20 |
5 |
35 |
9 |
63 |
Treatment of an uncomplicated acute severe malnutrition in the OTP
Manage the child as described in the table below:
| Drug |
Treatment |
| Vitamin A |
1 dose at admission to child with NO oedema and has not taken a dose within the last 6 months. |
| Folic Acid |
1 dose at admission Folic acid 5mg if the has anaemia |
| Amoxicillin |
one dose at admission + give treatment for 7 days to take at home the first dose should be given in the presence of the supervisor. |
| Deworming |
1 dose in the second week (2nd visit). |
| Measles vaccine (from 9 months old) |
1 vaccine on the 4th week (4th visit) if the child is not vaccinated or has no immunisation card. |
Dosage of Mebendazole or Albendazole for children > 2 years old
| Drug |
Give as a single dose if child has not got within the previous 6 months to these age groups |
| 2- 5 years |
| Albendazole 400mg tablet |
1 tablet |
| Mebendazole 500 mg tablet |
1 tablet |
| Mebendazole 100 mg tablets |
5 tablet |
- Give follow-up care for the child with uncomplicated severe malnutrition.
- Give follow-up care every 1 week.
Assess progress and check for any complications in every visit
1. Ask for:
- Diarrhoea, vomiting, fever or any other new complaint or problem.
- If the child is finishing the weekly RUTF ration.
2. Check:
- Weight; MUAC; Oedema; Temperature.
- For complications(pneumonia, watery or bloody diarrhoea, fever/low body temperature, measles, etc.follow).
- For appetite (do the test).
3. Decide on action
If there is any one of the following, refer to a health facility with inpatient care.
- If a medical complication exists.
- Increase or development of edema.
- Weight loss on 2 consecutive visits.
- Failure to gain weight on 3 consecutive visits.
- Major illness or death of the main caretaker so that the child can not be managed at home.
If there is no indication for referral, give:
- Deworming if this is the second visit.
- Give measles vaccines if this is the 4th visit.
- Weekly ration of Plumpy‘Nut or BP 100 according to weight.
- Appointment for follow-up
- Record the information on the OTP card.
Treatment of underweight in infants < 6 months old
- Assess the child's feeding and counsel the mother on feeding.
- If feeding problem, follow up in 5 days.
- If no feeding problem follows up in 30 days.
Treatment of children with moderate acute malnutrition > 6 months old
- Refer to a supplementary feeding program, if available.
- Assess the child's feeding and counsel the mother on feeding:
- If feeding problem, follow-up in 5 days.
- If no feeding problem follow up in 30 days.
- Advice mother when to return immediately.
Follow-up for moderate acute malnutrition
- If a child was classified with moderate acute malnutrition and referred to supplementary feeding center, or the mother has been given counselling to help her improve feeding and care of her child, she should be advised to return for a follow-up visit after 30 days. If there was a feeding problem as judged by the feeding recommendations in your chart booklet, the mother should be advised to return with the child earlier than 30 days.
- When the mother attends your health post for a follow-up visit after 30 days for a child with moderate acute malnutrition, you should measure MUAC and reassess feeding. You should praise the mother and encourage her to continue good home care for her child. This will ensure that she feels supported by you.
Treatment of children with no acute malnutrition
- If the child is less than 2 years, assess child's feeding and counsel the mother on feeding according to the food box above.
- If there is a feeding problem, follow-up in 5 days. If no feeding problems praise the mother‘