Component Task: Management of Moderate Acute Malnutrition (MAM)/Wasting

This is the process of identifying and correcting the nutritional disorder of a child with Moderate Acute Malnutrition (MAM). It is also a common potential life threatening condition in children aged 6–59 months characterized by moderate wasting (i.e. weight-for-height between –3 and –2 Z-scores of the WHO Child Growth Standards median) and/or mid-upper-arm circumference (MUAC) greater or equal to 11 cm and 12.5 cm.

Aims

·         Treat condition

·         Identify and treat associated infections and complications

·         Correct fluid and electrolyte imbalance and other complications

·         Correct the nutritional deficiency including vitamin A

·         Restore health by promoting growth and development

·         Prevent recurrence through counselling on the importance of adequate nutrition

·         Manage chronic illnesses

·         Provide nutritional rehabilitation

Requirements

a.      Feeding Tray containing

·         Nutritious Diet/Meal

·         Cup

·         Water

·         Straw

b.      Emergency tray

c.      Vital signs tray

Steps

1.        Receive child into a comfortable bed with caregiver support

2.      Perform five moments of hand hygiene

3.      Establish rapport (refer steps)

4.      Explain procedure to child/caregiver (refer steps)

5.      Provide privacy

6.      Incorporate developmentally appropriate strategies in dealing with the child

7.       Assess for the following:

·         Mid Upper Arm Circumference: 11.5 - < 12.5 cm

·         Weight for Age: < - 2 Z - Score but > - 3 Z Score

·         Weight for Height: < - 2 Z - Score but > - 3 Z Score

8.      Manage child on out-patient basis

·         Malnourished children who have appetite, and do not have any overt medical condition, which requires admission, should be managed as out-patients with Ready-to Use Therapeutic Food (RUTF); locally available nutritious meals

·         Supplementary foods; optimal food-based treatments

·         Energy intake of 25 kcal/kg/d in addition to the standard nutrient requirements of a non-malnourished child would support a reasonable rate of weight gain without promoting obesity

9.      Assist to take samples for FBC, Urea and electrolytes y Serum albumin, Urine culture and sensitivity, Blood culture and sensitivity, Chest X-ray, HIV testing, Gastric lavage for acid fast bacilli, Screen for common infections such as tuberculosis, pneumonia, urinary tract infections

10.    Ensure all immunizations are given

11.      Treat for worm infestations

12.    Continuous monitoring for child’s growth and development

13.    Encourage child/caregiver to report regularly for follow-ups

14.    Express appreciation to child/caregiver for their cooperation

15.    Encourage follow up/refer if necessary/conduct home visits as appropriate

16.    Document procedure in nurse’s note


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