Management of SAM children less than 6 months of age

  • Initial steps of management i.e. hypoglycemia, hypothermia, dehydration, infection, septic shock are same as for older children.
  • Feed the infant with appropriate milk feeds for initial recovery and metabolic stabilization. Wherever possible breastfeeding or expressed milk is preferred in place of Starter diet. If the production of breast milk is insufficient initially, combine expressed breast milk and non-cereal Starter diet initially. For nonbreastfed babies, give Starter diet feed prepared without cereals.
  • Provide support to re-establish breastfeeding as soon as possible. Support and help to express breast milk if the infant is too weak to suckle.
  • Give supplementary milk feeds if breast milk is not enough or if breastfeeding is not possible or mother is HIV +ve and has opted for replacement feeds.
  • Give good diet and micronutrient supplements to the mother.
  • In the rehabilitation phase, provide support to mother to give frequent feeds and try to establish exclusive breast feeding. In artificially fed without any prospects of breastfeeds, the infant should be given diluted Catch-up diet. [Catch-up diet diluted by one third extra water to make volume 135 ml in place of 100 ml].
  • On discharge the non-breastfed infants should be given locally available animal milk with cup and spoon. The infant formulas are very expensive and should only be advised if the parents can afford this.
  • Discharge the infant from the facility when gaining weight for 5 days and has no medical complications.
  • Relactation through Supplementary Suckling Technique - Supplementary Suckling Technique (SST) is a technique which can be used as a strategy to initiate relactation in mothers who have developed lactation failure.