Facility Based Management of Early Growth Failure (In first 6 months of life)

• Period of high velocity of somatic and neural growth.

• Growth failure identified by regular growth monitoring as sub normal anthropometry.

Criteria for admission in facility

Too weak to suckle effectively

Weight static or gain subnormal

Weight loss

W/L <-3SD

W/A <-3SD

Bilateral pedal pitting nutritional edema

Compartments of facility

SNCU/Postnatal/Pediatric ward/HBNC

Should be continuum of care since birth

Approach to a case U6mo

Triage

History

Examination

Test/Imaging

Identify medical complication

Anthropometry/review of growth charts

Assessment of nutritional risk

Counsel Mother

Address her Medical/social/nutritional problems

Correct position, attachment

SST with EBM/Donor mother milk/infnatformula/F75/F100dil

Prospects of BF

Management of children less than 6 months of age

• WHO 10 steps and management of complications are same

Algorithm for deciding level of care of infants U6M

Cont..

Medical management and micronutrient supplementation

Medical management and micronutrient supplementation

Management of SAM < 6 months with prospect of breastfeeding

• Correct positioning and attachment

• SST with F100 diluted

Factors affecting milk production

Good and Poor Attachment

Position of the mother

Supplementary Suckling Technique (SST)

Regulating quantity of catch up diluted (F-100 d)

Management of SAM < 6 months without prospect of breastfeeding

• Stabilization phase (medical complication and edema): Start F75

• Rehabilitation phase ( if no complication and edema): Start

F100 diluted

• Initially 2 and then 3 hourly feed

Outcome

• Good weight gain ≥ 10g/kg/day

• Moderate weight gain 5g to 10g/kg/day

• Poor weight gain >5g/kg/day

• Failure to respond

– Failure to regain appetite after 4 days of admission

– Failure to begin to lose odema from 4th day

– Edema still present after 10 days

THANK YOU