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TEN S T E P S TO M A N A G E S E V E R E L Y M A L N O U R I S H E D C H I L D R E N

M alnutrition affects the functioning of the organs of the body and warrants special care .during treatment especially in children. The following are the ten essential steps

involved in the care. (1-2) Treat/prevent hypoglycemia and hypothermia by frequent feeding to avoid infection

associated with these conditions.

(3) Treat/prevent dehydration by giving modified ORS solution (2 lts water, 1 It packet WHO-ORS, 50 g sugar and 40 ml electrolyte/mineral solution) Do not use the standard WHO oral rehydration salts solution.

(4) Correct electrolyte imbalance of excess sodium and less potassium and magnesium.

(5) Treat infection by routine administration of broad-spectrum antibiotic(s) and measles vaccine to unimmunised children in case of all admissions. Add specific antibiotics where specific infections identified.

(6) Correct micronutrient deficiencies. Do not give iron until the child has a good appetite and starts gaining weight.

(7) Start cautious feeding by providing just sufficient energy and protein to maintain basic physiological processes.

(8) Rebuild wasted tissues (catch-up growth) through frequent feeds (every four hours) of a catch-up diet and encourage breast feeding in breast fed children.

(9) Stimulation, play and loving care for mental and behavioural development.

(1,q) Preparation of follow-up after discharge by educating parents about feeding practices and playing with their children at home.

Abstracted f r o m : Health Dialogue; Issue no. 8," December 1996; pp 6-9.