Course Recognition and Management of Malnutrition

When using an ATFC manage children in their home with regular (ideally weekly) visits to the center and if possible a home visitor. The minimum stay in an ATFC program is 3 weeks. These children receive appropriate medical treatment for conditions that do not require hospitalization and RUTF. Infants 1 to 6 months of age can transfer to an ATFC when their medical complications have improved and they gain 10-15 g/kg/day for 5 consecutive days. Children 6 month to 10 years can be transferred to an ATFC or home when their edema has resolved; medical infections and other complications are resolving and no longer need oxygen, IV or IM treatment or close monitoring; the child’s appetite has normalized, and at least 2 weight measurements demonstrate an increasing trend. When an ATFC is not available ‘close to home” it is prudent to keep a child in the ITFC a little longer.

Children being managed in an ATFC or at home need admission or readmission to an ITFC if they develop signs of a severe medical complication with IMCI danger signs or a possible serious infection including HIV and TB. Nutritional reasons include development of edema, weight loss or poor weight gain (<5 g/ kg/day) after 2-3 weeks in the ATFC or home, failure of the appetite test.

Infants 1-6 months of age can be discharged from the ATFC when their W/H z score is > -2 on 2 consecutive visits and their weight is following their growth curve. Children 6 months to 10 years may be discharged from the ATFC when their MUAC is greater than 115 mm on 2 consecutive visits and their W/H z score is >/= -2 on 2 consecutive visits. Adolescents can be discharged when their W/H % is >80% on 2 consecutive visits.