Principles of hospital-based management

The principles of management of SAM are based on 3 phases:

  • Stabilization Phase
  • Transition Phase
  • Rehabilitative Phase

Stabilisation Phase-: Children with SAM without an adequate appetite and/or a major medical complication are stabilized in an in-patient facility. This phase usually lasts for 1–2 days. The feeding formula used during this phase is Starter diet which promotes recovery of normal metabolic function and nutrition-electrolytic balance. All children must be carefully monitored for signs of overfeeding or over hydration in this phase.

Transition Phase:-This phase is the subsequent part of the stabilization phase and usually lasts for 2-3 days. The transition phase is intended to ensure that the child is clinically stable and can tolerate an increased energy and protein intake. The child moves to the Transition Phase from Stabilization Phase when there is:

  • At least the beginning of loss of oedema


  • Return of appetite


  • No nasogastric tube, infusions, no severe medical problems


  • Is alert and active

The ONLY difference in management of the child in transition phase is the change in type of diet. There is gradual transition from Starter diet to Catch up diet (F 100).The quantity of Catch up diet (F100) given is equal to the quantity of Starter diet given in stabilization Phase.

Rehabilitation Phase:- Once children with SAM have recovered their appetite and received treatment for medical complications they enter Rehabilitation Phase. The aim is to promote rapid weight gain, stimulate emotional and physical development and prepare the child for normal feeding at home. The child progresses from Transition Phase to Rehabilitation Phase when:

  • She/He has reasonable appetite; finishes > 90% of the feed that is given, without a significant pause
  • Major reduction or loss of oedema
  • No other medical problem