Cebu City – Severe acute malnutrition (SAM) is a life-threatening condition that requires urgent treatment. It cannot be treated like other sick children. Correct identification of SAM can save a child’s life. Children with SAM are 9-12 times more likely to die than those who are well-nourished. Why is SAM treatment important? Simply because SAM can lead to death.

Severe acute malnutrition is when children suffer severe wasting. It occurs when infants and children do not have adequate energy, protein, and micronutrients in the diet combined with other health problems such as recurrent infections.

It is diagnosed when the circumference of the mid-upper arm is less than 11.5cm and the weight for height/length is less than -3SD and may or may not be accompanied by swelling of the body from fluid retention (edema).

Children with SAM should first be assessed with a full clinical examination to confirm whether they have any general danger signs, medical complications, and an appetite. A mother/caregiver should refer the child to the nearest health facility for the assessment.  

A SAM child with a loss of appetite or has any medical complications should be admitted for inpatient care while children who have a good appetite and no medical complications can be managed as outpatient care.

Outpatient Therapeutic Care (OTC) – can be done at home or at any health facility. It is applicable for SAM infants/children with good appetites and no medical complications. It involves giving routine meds and ready-to-use therapeutic food (RUTF). The duration of the treatment is 90 days but depends on the progression of the child’s weight. If the child’s normal weight has already been attained the patient can be discharged. It needs to be monitored closely for the child to be fully discharged.

Inpatient Therapeutic Care (ITC) – a child who fails the appetite test or has any medical complications such as vomiting, hyperthermia, hypothermia, anemia, extreme superficial infection, altered alertness, dehydration, and tachypnea shall be admitted to an ITC. Inpatient entails medical and nutritional treatment. Different protocols exist in the management of those less than 6 months versus over 6-59 months. Therapeutic food helps facilitate treatment and recovery in both inpatient and outpatient settings. These are some of the therapeutic foods:

• F-75 - caloric density of 75 kcal/100 ml, low in protein, fat, and sodium, and rich in carbohydrates.
• F-100 - caloric density of 100 kcal/100 ml, the nutritional value is equal to RUTF, and it is used as therapeutic milk for <6 months old infants.
• RUTF – have 500 kcal/96 g sachet, consists of a peanut-based paste, with sugar, vegetable fat, and skimmed milk powder, enriched with vitamins and minerals.
• ReSoMal – Rehydration Solution for Malnutrition, should be used as the standard therapy for children with SAM diagnosed with dehydration.

SAM treatment needs skilled and trained health workers because the child needs to be monitored closely. If the child is discharged without completing the procedures, he/she continues to be at risk.

For the prevention of SAM, children should be referred to the Therapeutic Supplementary Feeding Program (TSFP) if available or other supplementary or school feeding programs. There are available IYCF / nutrition counseling (e.g. IYCF peer counseling, family development sessions, Pabasa sa nutrisyon, promotion of good nutrition), mother support groups, a well-baby clinic, multiple micronutrient supplementation, or complementary feeding support. The child must be enrolled in a growth monitoring program/Operation Timbang Plus for close follow-up.

Family and community support are essential for a successful SAM management program. // ND II Sarah Belle I. Antiola, RND