Therapeutic feeding

Phases of Therapeutic feeding

1. Stabilisation phase or Phase 1 (I)

a. High risk for hypothermia, hypoglycaemia and infections

b. All children are initially put on F-75 feeds 8 times per day Feeding charts

c. If appetite is returning, child is more active and alert, complications are treated and oedema is visibly decreasing THEN change to Transition phase

2. Transition phase (TR)

a. Prescribe F75/RUTF(Chiponde) using Feeding charts

b. Let the child eat the Chiponde first, then if it is still having appetite, give F75 to ensure sufficient caloric intake. If the child finishes the Chiponde (even after 1 day), STOP the F75

c. Within 2 to 3 days, 'transition' to Chiponde only. Stop F75. If the child finishes after 1 day on Chiponde, STOP the F75.

d. Let the clinical condition of the child guide these decisions

e. Use only F100 when a child is UNABLE to chew RUTF ('Chiponde'); in the same volume as it was given with F75

3. Rehabilitation Phase or Phase 2 (II)

a. When the child is finishing all the Chiponde, is losing oedema and (ideally) has started to gain weight, the child is discharged home on Chiponde only

b. Use Feeding charts to ensure extra caloric intake during this final catch-up phase (200 kcal/kg/day). At this point the child is active, alert and free of complications

4. When to move back a phase?

a. If worsening of vomiting or diarrhoea, increasing oedema or signs of fluid overload, loss of appetite (i.e. have WHO danger signs again): move back to Phase I and review the same day.

b. If increase of vomiting/diarrhoea on F75 consider stopping feeds and putting child on IV fluids to let the gut 'rest' (with either IV or ReSoMal supplementation for ongoing losses). Always discuss with senior. Those children need to be admitted in HDU and monitored closely for all vital signs. If no ReSoMal available, give ORS instead

• Place NGT if the child finishes less than 75% of the formula milk for 2 consecutive feeds. Other reasons for inserting an NGT are reduced level of consciousness, Cerebral Palsy with oral intake problems, lethargy or convulsions, pneumonia with rapid breathing, painful lesions in the mouth or a cleft palate/ oral deformity.
• The NGT should be removed when the child takes 75% of the day's diet orally, or takes 2 consecutive feeds fully by mouth. While having an NGT, stimulate orally every feed unless strictly on NPO
• If possible, continue breastfeeding (including HIV exposed children). To ensure good lactation, the mother should breastfeed before the child is fed with F75

Feeding Procedure concerning RUTF

• The caregiver should feed the child small amounts of RUTF and the child should finish the allocated daily ration before given any other food (with the exception of breast milk)
• The caregiver should encourage the child to eat as often as possible (every 3 hours during the day)
• If the child is breastfeeding, the mother should offer breast milk on demand and before feeding with RUTF
• The caregiver should give plenty of drinking water while feeding the child RUTF to keep the child hydrated
• Do not mix RUTF with liquids; this might foster bacterial growth
• Do not mix RUTF with other food