10.3.3 Routine drugs
In addition to the RUTF, severely malnourished children need to be routinely given drugs using the administration schedule outlined in Table 10.5 overleaf.
Table 10.5 Routine drugs to be administered to children with severe acute malnutrition.
Ask if it has been given in the last six months
Give one dose at admission if one not given previously
Do not give a dose of vitamin A if the child has oedema
|Folic acid||One dose at admission|
|Amoxicillin||One dose at admission and give seven days treatment to take home|
|The first dose should be given in the presence of the supervisor|
|De-worming||One dose in the second week (second visit)|
|Malaria||According to national protocol (see the study session on malaria in the IMNCI module)|
|Measles (from nine months old)||Ask if the child has been vaccinated|
|Give one vaccine on the fourth week (fourth visit) if not given previously|
|Iron||Not given - iron is already in all RUTF|
As you see from the information in Table 10.5, if a child is admitted to your health post for treatment of severe acute malnutrition you should always give them a dose of vitamin A, unless the child has oedema or has received vitamin A in the previous six months.
A severely malnourished child should be given antibiotics even if there are no signs of infection.
Note that severely malnourished children should be given antibiotics (Amoxicillin) even if they do not have signs of infection such as fever. Fever results from an immune response of the body to an infectious agent. As a severely malnourished child has a very weak immune system, it often fails to develop a fever response. Therefore a severely malnourished child should be given antibiotics without waiting for typical signs of infection.
Always make sure that the caregiver gives the child the first dose of the drugs in your presence. This will give you an opportunity to make sure that they are able to administer it appropriately. The caregiver can then confidently replicate what they have done in your presence, when caring for the child at home.
After completing the anthropometry and deciding whether a child is severely malnourished, what must you do next to decide whether a child needs to be treated as an in-patient?
You should first consider the child’s age because children under six months with SAM always need to be cared for in an in-patient faculty. You would then check for the presence of complications and finally you would do the appetite test.