Micronutrient supplementation

Vitamin A: Give Vitamin A in a single dose to all SAM children unless there is evidence that child has received vitamin A dose in last 1 month.

Recommended oral dose of Vitamin A according to child’s age

Age Vitamin A dose
< 6 months 50 000 IU
6–12 months or if weight <8Kg 100 000 IU
>12 months 200 000 IU
  • Give same dose on Day 1, 2 and 14 if there is clinical evidence of vitamin A deficiency.
  • Children more than twelve months but having weight less than 8 kg should be given 100,000 IU orally irrespective of age.
  • Oral treatment with vitamin A is preferred, except for initial treatment of. For oral administration, an oilbased formulation is preferred.
  • IM treatment should be used in children with severe anorexia, oedematous malnutrition, or septic shock. Only water-based formulations and half of oral dose should be used.

Other micronutrients should be given daily for at least 2 weeks:

  • Multivitamin supplement (should contain vitamin A, C, D, E and B12 and not just vitamin B-complex): Twice Recommended Daily Allowance
  • Folic acid: 5 mg on day 1, then 1 mg/day
  • Elemental Zinc: 2 mg/kg/day
  • Copper: 0.3 mg/kg/day (if separate preparation not available use commercial preparation containing copper)
  • Iron: Start daily iron supplementation after two days of the child being on Catch up diet. Give elemental iron in the dose of 3 mg/kg/day in two divided doses, preferably between meals. (Do not give iron in stabilization phase.)