Poor indicator to response during treatment of malnutirion includes -
Failure to gain appetite by day 10
Presence of edema on day 10
Failure to gain at least 5 g/kg/day by day 4
All
Ans is 'b' i.e., Presence of edema on day 10 Guidelines on Hospital based management of severely malnourished children o The curent guidelines recommended in-patient (hospital) management of all severely malnourished children are divided into ten essential steps: Treat/prevent hypoglycemia Treat/prevent hypothermia Treat/prevent dehydration Correct electrolyte imbalance Treat/prevent infection Correct micronutrient deficiencies Sta cautious feeding Achieve catch-up growth Provide sensory stimulation and emotional suppo Prepare for follow-up after recovery. Monitoring progress during treatment o Good weight gain is >10 g/kg/day and indicates a good response. It is recommended to continue with the same treatment. o Moderate weight gain is 5-10 g/kg/day; food intake should be checked and the children should be screened for systemic infection. Poor weight gain is < 5g/kg/day, screening for inadequate feeding, untreated infection, tuberculosis and psychological problems is recommended. Indicators of failure to respond Primary failure to respond is indicated by: Failure to regain appetite by day 4. Failure to sta losing edema by day 4. o Presence of edema on day 10. Failure to gain at least 5.g/kg/day by day 10. o Secondary failure to respond is indicated by failure to gain at least 5g/kg/day for 3 consecutive days during the rehabilitation phase. Criteria for discharge o Severely malnourished children are ready for discharge when the following criteria have been fulfilled: (i) Absence of infection. (ii) The child is eating at least 120-130 cal/kg/day and receiving adequate micronutrients. (iii) There is consistent weight gain (of at least 5 g/kg/day for 3 consecutive days) on exclusive oral feeding. (iv) WFH is 90% of NCHS median; The child is still likely to have a low weight-for-age because of stunting. (v) Absence of edema. (vi) Completed immunization appropriate for age. Caretakers are sensitized to home care.