Poor indicator to response during treatment of malnutrition includes –
Presence of edema on day 10
Failure to gain at least 5g/kg/day by day 10
Failure to gain at least 5g/kg/day for 3 consecutive days during the rehabilitation phase
All of these
Guidelines on Hospital based management of severely malnourished children

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
Start cautious feeding
Achieve catch-up growth
Provide sensory stimulation and emotional support
Prepare for follow-up after recovery.

Monitoring progress  during treatment

Good weight gain is >10 g/kg/day and indicates a good response. It is recommended to continue with the same treatment.
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 psycho-logical problems is recommended.

Indicators of failure to respond 

Primary failure to respond is indicated by:
Failure to regain appetite by day 4.
Failure to start losing edema by day 4.
Presence of edema on day 10.
Failure to gain at least 5.g/kg/day by day 10.
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


Severely malnourished children are ready for discharge when the following criteria have been 'Wiled:


The absence of infection.
The child is eating at least 120-130 cal/lcg/day and receiving adequate micronutrients.
There is consistent weight gain (or at least 5 g/kg/day for 3 consecutive days) on exclusive oral feeding.
WFH is 90% of NCHS median; The child is still likely to have a low weight-for-age because of stunting.
The absence of oedema.
Completed immunization appropriate for age.
Caretakers are sensitized to home care.