HANDOUT 8.4. Entry, Transition, and Exit Criteria for Specialized Food Products [revise according to locally available products and national protocol] Target group Entry criteria Prescription (RUTF or RUSF or FBF) Transition/exit criteria Infants < 6 Severe acute malnutrition (SAM) Inpatient treatment: Transition to outpatient treatment of months SAM if: Any pitting edema Establish or re-establish effective exclusive breastfeeding, including relactation if possible. If this is No clinical conditions or medical OR not possible, encourage wet nursing. complications, including edema Weight-for-length z-score < –3 Provide a supplementary feed: AND OR Good appetite Prioritize supplementary suckling if feasible. Recent weight loss or failure to gain weight If no edema: feed expressed breast milk. If this AND is not possible, feed commercial infant formula OR Clinical wellness and alertness or F-75 or diluted F-100, either alone or as the Danger sign (inability to drink or supplementary feed, together with breast milk. AND breastfeed, severe vomiting, If edema: Feed infant formula or F-75 together convulsions, lethargy, unconsciousness) Weight gain of > 5 g/kg/day for at least with breast milk. Do NOT give undiluted F-100. 3 successive days OR If no realistic prospect of breastfeeding: Use Ineffective feeding (positioning, appropriate and adequate replacement Discharge from all care if: attachment, suckling) products, such as commercial infant formula, Effective breastfeeding or feeding well with support for safe preparation and use, OR with replacement foods including at home when discharged. Any medical or social issue needing AND more detailed assessment or intensive Note: If caregiver declines inpatient treatment, counsel support (e.g., disability, depressed on and support optimal infant feeding, monitor weekly Adequate weight gain caregiver, other adverse social to observe changes, and refer to inpatient treatment if AND circumstances) infant is not gaining weight. Weight-for-length z-score ≥ –2
HANDOUT 8.4. Entry, Transition, and Exit Criteria for Specialized Food Products [revise according to locally available products and national protocol] Target group Entry criteria Prescription (RUTF or RUSF or FBF) Transition/exit criteria Infants < 6 months Severe acute malnutrition (SAM) Any pitting edema OR Weight-for-length z-score < –3 OR Recent weight loss or failure to gain weight OR Danger sign (inability to drink or breastfeed, severe vomiting, convulsions, lethargy, unconsciousness) OR Ineffective feeding (positioning, attachment, suckling) OR Any medical or social issue needing more detailed assessment or intensive support (e.g., disability, depressed caregiver, other adverse social circumstances) Inpatient treatment: Establish or re-establish effective exclusive breastfeeding, including relactation if possible. If this is not possible, encourage wet nursing. Provide a supplementary feed: Prioritize supplementary suckling if feasible. If no edema: feed expressed breast milk. If this is not possible, feed commercial infant formula or F-75 or diluted F-100, either alone or as the supplementary feed, together with breast milk. If edema: Feed infant formula or F-75 together with breast milk. Do NOT give undiluted F-100. If no realistic prospect of breastfeeding: Use appropriate and adequate replacement products, such as commercial infant formula, with support for safe preparation and use, including at home when discharged. Note: If caregiver declines inpatient treatment, counsel on and support optimal infant feeding, monitor weekly to observe changes, and refer to inpatient treatment if infant is not gaining weight. Transition to outpatient treatment of SAM if: No clinical conditions or medical complications, including edema AND Good appetite AND Clinical wellness and alertness AND Weight gain of > 5 g/kg/day for at least 3 successive days Discharge from all care if: Effective breastfeeding or feeding well with replacement foods AND Adequate weight gain AND Weight-for-length z-score ≥ –2
Generic-NACS-Participant-Handouts-Dec2015.docx