WHO changes approach to treating severely malnourished children

New guidelines say children suffering from severe acute malnutrition need not be hospitalised, and can be treated more effectively at home

By Jyotsna Singh
Published: Thursday 28 November 2013


The World Health Organization (WHO) has issued new guidelines to treat children suffering from severe acute malnutrition (SAM). As against the earlier approach of treating such children in hospitals, the new approach recognises that treating SAM children at home is more effective. The new guidelines have also made changes in recommendations for infants under-six months suffering from SAM. The new recommendations suggest that alternative methods of feeding the child, such as milk banks, should be used in case the mother is unable to breast feed. The guidelines emphasise on the use of antibiotics to treat these children.

The new guidelines supersede those issued by WHO in 1999, which recommended that all severely malnourished children be hospitalised, given fortified formula milk and appropriate treatment, including antibiotics. In the light of new technologies, the new guidelines effect a paradigm shift. SAM children, who have appetite and are not suffering from any evident medical condition that requires hospitalisation, are to be effectively treated at home with specially-formulated foods that provide energy and nutrients. In addition, antibiotic medicines like amoxicillin are also recommended to treat infection.

“It’s generally better for children and better for their families if they’re treated as outpatients,” says Elizabeth Mason, director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health. “It can be easier for families who need to continue providing and caring for other children and it allows vulnerable, malnourished children to stay home and avoid the risk of getting hospital infections.”

The guidelines say proactive use of antibiotics is important because the immune system of a SAM child can virtually shut down. This lack of immune response means two things—the body cannot fight off infection and medical tests may not detect infection, even when one is present. According to the guidelines, evidence suggests that giving a broad spectrum antibiotic such as amoxicillin enables the child’s body to fight off common infections like pneumonia and urinary tract infections which can  otherwise be fatal to this group of children.

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