Feeding child with SAM

Cautious feeding in stabilisation phase

  • Feeding should begin as soon as possible after admission with ‘Starter diet’ until the child is stabilized. This is a phase when the child recovers normal metabolic function and nutrition-electrolytic balance and but there is NO weight gain. Severely malnourished children cannot tolerate usual amounts of protein and sodium at this stage, or high amounts of fat. Starter diet is low in protein and sodium and high in carbohydrate, which is more easily handled by the child and provides much-needed glucose. contains 75 kcal and 0.9 g protein per 100 ml. (Recipe for preparing ‘Starter diet’ is given in annexure 13)
  • Give starter formula , calculating the required daily amount for each child using Starter diet Reference Chart given in annexure 14 and 15.
  • Give 8-12 feeds over 24 hours
  • If the child has gross oedema, reduce the volume to 100 ml/kg/day (see feed chart for amounts)
  • If the child has poor appetite, coax and encourage the child to finish the feed. If eating 80% or less of the amount offered, use a nasogastric tube. If in doubt, see feed chart for intakes below which tube feeding is needed.
  • Keep a 24-hour intake chart. Measure feeds carefully. Record leftovers.
  • If the child is breastfed, encourage continued breastfeeding but also give starter formula.
  • Transfer to starter formula as soon as appetite has returned (usually within one week) and oedema has been lost or is reduced
  • Weigh daily and plot weight.